Provider Demographics
NPI:1396138715
Name:EXCEL PERFORMANCE PHYSICAL THERAPY, P.C.
Entity type:Organization
Organization Name:EXCEL PERFORMANCE PHYSICAL THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:831-566-2004
Mailing Address - Street 1:121 WAUGH AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95065-1133
Mailing Address - Country:US
Mailing Address - Phone:831-566-2004
Mailing Address - Fax:831-325-0307
Practice Address - Street 1:2650 RESEARCH PARK DR
Practice Address - Street 2:
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-2087
Practice Address - Country:US
Practice Address - Phone:831-566-2004
Practice Address - Fax:831-325-0307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-10
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36994261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy