Healthcare Provider Details

I. General information

NPI: 1174343529
Provider Name (Legal Business Name): EXCEL PHYSICAL THERAPY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2024
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8670 BROADWAY STE CB
MERRILLVILLE IN
46410-7051
US

IV. Provider business mailing address

8670 BROADWAY STE CB
MERRILLVILLE IN
46410-7051
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. AMIRA FAIZANA MOHAMMED
Title or Position: FOUNDER, DPT
Credential: DPT
Phone: 219-397-7771