Healthcare Provider Details

I. General information

NPI: 1235285065
Provider Name (Legal Business Name): EXCEL PHYSICAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 08/30/2022
Certification Date: 01/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E PERSHING ST
SALEM OH
44460-3047
US

IV. Provider business mailing address

PO BOX 366
LISBON OH
44432-0366
US

V. Phone/Fax

Practice location:
  • Phone: 330-424-9033
  • Fax: 330-424-9053
Mailing address:
  • Phone: 330-424-9033
  • Fax: 330-424-9053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT6697
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GEORGE A SUMMERS
Title or Position: OWNER
Credential: PT, MPT, OCS
Phone: 330-868-4362