Provider Demographics
NPI:1154546471
Name:EXCEL PHYSICAL THERAPY INC
Entity type:Organization
Organization Name:EXCEL PHYSICAL THERAPY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:GALLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:MPT, OT
Authorized Official - Phone:404-229-5754
Mailing Address - Street 1:1883 MCDONOUGH ROAD
Mailing Address - Street 2:BLDG 200 SUITE C
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-3517
Mailing Address - Country:US
Mailing Address - Phone:770-603-7050
Mailing Address - Fax:770-603-7049
Practice Address - Street 1:1883 MCDONOUGH ROAD
Practice Address - Street 2:BLDG 200 SUITE C
Practice Address - City:HAMPTON
Practice Address - State:GA
Practice Address - Zip Code:30228-3517
Practice Address - Country:US
Practice Address - Phone:770-603-7050
Practice Address - Fax:770-603-7049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT004026225100000X
261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP6919Medicare ID - Type Unspecified