Healthcare Provider Details

I. General information

NPI: 1215775275
Provider Name (Legal Business Name): EXCEL PERFORMANCE HEALTH AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2024
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PALISADES PL
PACIFIC WA
98047-5003
US

IV. Provider business mailing address

100 PALISADES PL
PACIFIC WA
98047-5003
US

V. Phone/Fax

Practice location:
  • Phone: 646-982-7585
  • Fax:
Mailing address:
  • Phone: 646-982-7585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANGELITO MABINI
Title or Position: MANAGER
Credential: MPT
Phone: 253-988-4116