Provider Demographics
NPI:1104133180
Name:EXCELSERV PLLC
Entity type:Organization
Organization Name:EXCELSERV PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:PALMIERI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:435-817-8100
Mailing Address - Street 1:340 SNOW CANYON DR
Mailing Address - Street 2:# 15
Mailing Address - City:IVINS
Mailing Address - State:UT
Mailing Address - Zip Code:84738-6495
Mailing Address - Country:US
Mailing Address - Phone:435-817-8100
Mailing Address - Fax:
Practice Address - Street 1:340 SNOW CANYON DR
Practice Address - Street 2:# 15
Practice Address - City:IVINS
Practice Address - State:UT
Practice Address - Zip Code:84738-6495
Practice Address - Country:US
Practice Address - Phone:435-817-8100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-11
Last Update Date:2010-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5062225100000X
NV1744225100000X
UT372070-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty