1649344946 NPI number — EXCEL PHYSICAL THERAPY INC

Table of content: (NPI 1649344946)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649344946 NPI number — EXCEL PHYSICAL THERAPY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EXCEL PHYSICAL THERAPY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649344946
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/30/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
912 E LINCOLNWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINERVA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44657-1214
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-868-4362
Provider Business Mailing Address Fax Number:
330-424-9053

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
912 E LINCOLNWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MINERVA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44657-1214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-868-4362
Provider Business Practice Location Address Fax Number:
330-424-9033
Provider Enumeration Date:
11/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SUMMERS
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER, PHYSICAL THERAPIST
Authorized Official Telephone Number:
330-868-4362

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT6697 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2133588 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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