1639129935 NPI number — EXCEL PHYSICAL THERAPY LLC

Table of content: (NPI 1639129935)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639129935 NPI number — EXCEL PHYSICAL THERAPY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EXCEL PHYSICAL THERAPY LLC
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:
1639129935
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/18/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2285 WHITNEY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAMDEN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06518
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-288-6977
Provider Business Mailing Address Fax Number:
203-230-8444

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2285 WHITNEY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMDEN
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-288-6977
Provider Business Practice Location Address Fax Number:
203-230-8444
Provider Enumeration Date:
05/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BUSEL
Authorized Official First Name:
DATNA
Authorized Official Middle Name:
ESTHER
Authorized Official Title or Position:
OWNER DIRECTOR
Authorized Official Telephone Number:
203-288-6977

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0102301 . This is a "ORTHONET HEALTHNET" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 080004966CT02 . This is a "ANTHEM BLUE CROSS/BLUE SH" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: A3184524 . This is a "OXFORD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 3001821 . This is a "CIGNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 3567925 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 2V8129 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6605951 . This is a "GHI" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 682977 . This is a "ACN GROUP" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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