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General NPI Number Information
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NPI Number | 1023508348
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Entity Type | Organization
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Legal Business Name | EXCEED PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 05/11/2018
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Last Update Date | 05/11/2018
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Provider Practice Location Address
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Address Line | 12261 HIGHWAY 49 STE 1
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City | GULFPORT
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State | MS
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Zip | 39503-2976
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Country | US
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Telephone | 228-861-4218
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Fax |
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Provider Business Mailing Address
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Address Line | 3 BAYOU PL
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City | GULFPORT
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State | MS
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Zip | 39503-6202
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Country | US
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Telephone | 228-861-4218
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | CHAD BLALACK
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Credential |
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Telephone | 228-860-9676
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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