Healthcare Provider Details

I. General information

NPI: 1528344934
Provider Name (Legal Business Name): EXCEL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2011
Last Update Date: 06/27/2022
Certification Date: 06/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3420 E 15TH ST
PANAMA CITY FL
32405-7425
US

IV. Provider business mailing address

3420 E 15TH ST
PANAMA CITY FL
32405-7425
US

V. Phone/Fax

Practice location:
  • Phone: 850-215-8844
  • Fax: 850-215-6644
Mailing address:
  • Phone: 850-215-8844
  • Fax: 850-215-6644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MR. BRYAN DAVIS
Title or Position: CO-OWNER
Credential: P.T., D.P.T
Phone: 850-832-7587