Provider Demographics
NPI:1194964155
Name:EXCELLENT THERAPY CLINIC, LLC
Entity type:Organization
Organization Name:EXCELLENT THERAPY CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTIMBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-279-6216
Mailing Address - Street 1:3815 S SUGAR RD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-9638
Mailing Address - Country:US
Mailing Address - Phone:956-383-4454
Mailing Address - Fax:956-383-4979
Practice Address - Street 1:3815 S SUGAR RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-9638
Practice Address - Country:US
Practice Address - Phone:956-383-4454
Practice Address - Fax:956-383-4979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-16
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherTAX ID