Healthcare Provider Details

I. General information

NPI: 1750477873
Provider Name (Legal Business Name): EXCEL PHYSICAL THERAPY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

523 W CHICAGO AVE
EAST CHICAGO IN
46312-3206
US

IV. Provider business mailing address

7231 JEFFREY ST
SCHERERVILLE IN
46375-3512
US

V. Phone/Fax

Practice location:
  • Phone: 219-397-7771
  • Fax: 219-397-7771
Mailing address:
  • Phone: 219-670-4288
  • Fax: 219-397-7771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number StateIN

VIII. Authorized Official

Name: MS. AMIRA FAIZANA MOHAMMED
Title or Position: PHYSICAL THERAPIST
Credential:
Phone: 219-670-4288