Healthcare Provider Details

I. General information

NPI: 1356818652
Provider Name (Legal Business Name): EXCELARATE PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2018
Last Update Date: 10/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 HARRISON LN
BRUNSWICK GA
31520-1959
US

IV. Provider business mailing address

216 HARRISON LN
BRUNSWICK GA
31520-1959
US

V. Phone/Fax

Practice location:
  • Phone: 678-699-4036
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. SONYA DENISE ROLAND
Title or Position: OWNER - PHYSICAL THERAPIST
Credential:
Phone: 678-699-4036