Provider Demographics
NPI:1912949264
Name:ECCLEAGE THERAPY LLC
Entity Type:Organization
Organization Name:ECCLEAGE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:IKECHUKWU
Authorized Official - Middle Name:
Authorized Official - Last Name:UMEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-800-3200
Mailing Address - Street 1:220 W NOLANA AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2513
Mailing Address - Country:US
Mailing Address - Phone:956-800-3200
Mailing Address - Fax:
Practice Address - Street 1:39614 MILE 7 RD
Practice Address - Street 2:
Practice Address - City:PENITAS
Practice Address - State:TX
Practice Address - Zip Code:78576-7515
Practice Address - Country:US
Practice Address - Phone:956-800-3200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX184190002Medicaid
TX676648Medicare Oscar/Certification