1548621725 NPI number — EXCEL PHYSICAL THERAPY INC

Table of content: (NPI 1548621725)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548621725 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:
1548621725
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4029 NORTHWEST AVE STE 302
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLINGHAM
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98226-9077
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-734-2277
Provider Business Mailing Address Fax Number:
360-734-3006

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1863 MAIN ST STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FERNDALE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98248-9059
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-656-6534
Provider Business Practice Location Address Fax Number:
360-778-1637
Provider Enumeration Date:
03/15/2016

Additional Information

Authorized Official

Authorized Official Last Name:
OBERGOTTSBERGER
Authorized Official First Name:
LISA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
360-734-2277

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  00006753 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7128838 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com