Healthcare Provider Details

I. General information

NPI: 1154546471
Provider Name (Legal Business Name): EXCEL PHYSICAL THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 05/12/2022
Certification Date: 05/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1883 MCDONOUGH ROAD BLDG 200 SUITE C
HAMPTON GA
30228-3517
US

IV. Provider business mailing address

1883 MCDONOUGH ROAD BLDG 200 SUITE C
HAMPTON GA
30228-3517
US

V. Phone/Fax

Practice location:
  • Phone: 770-603-7050
  • Fax: 770-603-7049
Mailing address:
  • Phone: 770-603-7050
  • Fax: 770-603-7049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT004026
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFFREY ALLEN GALLOWAY
Title or Position: OWNER
Credential: MPT, OT
Phone: 404-229-5754