Healthcare Provider Details

I. General information

NPI: 1972161461
Provider Name (Legal Business Name): EXCELLENT THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2019
Last Update Date: 01/08/2022
Certification Date: 01/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7855 NW 12TH ST STE 114
DORAL FL
33126-1818
US

IV. Provider business mailing address

7855 NW 12TH ST STE 114
DORAL FL
33126-1818
US

V. Phone/Fax

Practice location:
  • Phone: 786-803-8550
  • Fax: 786-803-8370
Mailing address:
  • Phone: 786-803-8550
  • Fax: 786-803-8370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: VIVIAN CHAVEZ
Title or Position: PRESIDENT
Credential:
Phone: 786-803-8550