Healthcare Provider Details

I. General information

NPI: 1740322304
Provider Name (Legal Business Name): EXCEL PHYSICAL THERAPY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 02/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4029 NORTHWEST AVE SUITE #302
BELLINGHAM WA
98226-9077
US

IV. Provider business mailing address

4029 NORTHWEST AVE SUITE #302
BELLINGHAM WA
98226-9077
US

V. Phone/Fax

Practice location:
  • Phone: 360-734-2277
  • Fax: 360-734-3006
Mailing address:
  • Phone: 360-734-2277
  • Fax: 360-734-3006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number00006753
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier7128838
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer

VIII. Authorized Official

Name: LISA OBERGOTTSBERGER
Title or Position: OWNER
Credential: PT
Phone: 360-734-2277