MEDICARE: EXCEL REHABILITATION AND SPORTS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	225000000X	Orthotic Fitter
2	2251S0007X	Sports Physical Therapist
3	2251X0800X	Orthopedic Physical Therapist
4	225X00000X	Occupational Therapist
5	225XH1200X	Hand Occupational Therapist
6	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1740358324
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXCEL REHABILITATION AND SPORTS

Provider Business Mailing Address
First Line	:	625 KENMOOR AVE SE STE 100
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49546-2395
Country	:	US
Telephone Number	:	616-356-5000
Fax Number	:	616-356-5001

Provider Business Practice Location Address
First Line	:	501 FOREST LN
Second Line	:	SUITE A
City	:	CLEMSON
State	:	SC
Zip	:	29631-2621
Country	:	US
Telephone Number	:	864-654-2001
Fax Number	:	800-305-7112

Authorized Official
Title or Position	:	CEO
Name	:	MR. RICHARD LEAVER
Credential	:	PT
Telephone Number	:	166-356-5000

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	05/30/2025

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1912098401 — MR. DAVID EUGENE BRIGHT MPT
Practice Location Address:

501 FOREST LN , SUITE A
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1669569190 — MR. DOUGLAS J LAUBER OTR/L,CHT
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1053486613 — MR. JONATHAN MICHAEL ALEXANDER PT
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501 FOREST LN , SUITE A
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29631-2621

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1619042694 — MRS. KIRSTEN SOLBERG SNAPE MPT
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501 FOREST LN , SUITE A
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29631-2621

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1033346572 — KRISTEN HEATHER MONZO PT
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501 FOREST LN STE A
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1740507581 — KATHRYN BETH RAWDAN M.D.
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