Agave Therapy, LLC
Organization Active NPI Physical Therapist · Alpine, TX
NPI 1992464523 · NPPES record last updated Dec 10, 2021
Key facts
- NPI
- 1992464523
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Therapist 225100000X
- Legal business name
- AGAVE THERAPY, LLC
- Practice address
- 610 E Holland Ave
Alpine, TX 79830-4830 - Phone
- (432) 837-5907
- Fax
- (866) 523-1745
- NPI assigned
- Dec 10, 2021
- Organization subpart
- Yes
- Parent organization (as reported)
- AGAVE HOME HEALTH LLC
Authorized official
- Name
- Angela Juett, RN
- Title
- President and Secretary
- Phone
- (432) 837-5907
Parent organization (reported in NPPES) 1
Practitioners 8
-
Laura Snodgrass, OTR
-
Edgar Allan Liwanag Benusa, PT, DPT
-
Wikar A Kadhim, OT
-
Joanie Marie Weber, P.T.
-
Rachel Guenat, P. T.
-
Holly McMurray, PT, DPT
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220118000851 | TX | Part B Supplier - Clinic/Group Practice | 7113319468 |
Receives reassigned benefits from 6 practitioners Practice locations: Alpine, TX |
National Provider Directory
- Part of
- Agave Home Health LLC
Locations
610 E Holland Ave
Alpine, TX 79830
Phone (432) 837-5907
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist |
225100000X | Yes | ||
| Occupational Therapist |
225X00000X | |||
| Speech-Language Pathologist |
235Z00000X |
Addresses
Primary practice location
610 E Holland Ave
Alpine, TX 79830-4830
Mailing address
610 E Holland Ave
Alpine, TX 79830-4830
Phone (432) 837-5907
Other providers in Alpine, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 10, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.