Provider Demographics
NPI:1306132188
Name:EXCEL PHYSICAL & OCCUPATIONAL THERAPY
Entity type:Organization
Organization Name:EXCEL PHYSICAL & OCCUPATIONAL THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:PTA, ATC
Authorized Official - Phone:719-533-0021
Mailing Address - Street 1:4083 AUSTIN BLUFFS PKWY
Mailing Address - Street 2:SUITE 101-A
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-5904
Mailing Address - Country:US
Mailing Address - Phone:719-533-0021
Mailing Address - Fax:719-533-1106
Practice Address - Street 1:4083 AUSTIN BLUFFS PKWY
Practice Address - Street 2:SUITE 101-A
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-5904
Practice Address - Country:US
Practice Address - Phone:719-533-0021
Practice Address - Fax:719-533-1106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy