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General NPI Number Information
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NPI Number | 1073788931
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Entity Type | Organization
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Legal Business Name | EXCEL GROWTH THERAPIES, LLC
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Dates
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Enumeration Date | 04/22/2008
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 10105 S FULTON DR
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City | FREDERICKSBURG
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State | VA
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Zip | 22408-0260
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Country | US
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Telephone | 571-931-7420
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Fax | 877-771-3419
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Provider Business Mailing Address
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Address Line | 10105 S FULTON DR
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City | FREDERICKSBURG
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State | VA
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Zip | 22408-0260
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Country | US
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Telephone | 571-931-7420
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Fax | 877-771-3419
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Authorized Official
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Title or Position | DIRECTOR
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Name | DENIECE MARAGRITA' PAYNE
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Credential |
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Telephone | 571-330-8120
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number |
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2305204162
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2306000431
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State | VA
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Taxonomy #5
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Taxonomy Code | 225600000X
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Taxonomy Name | Dance Therapist
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License Number |
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License Number State | VA
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Taxonomy #6
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Taxonomy Code | 225CA2400X
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Taxonomy Name | Assistive Technology Practitioner Rehabilitation Counselor
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 225CA2500X
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Taxonomy Name | Assistive Technology Supplier Rehabilitation Counselor
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 235500000X
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Taxonomy Name | Speech/Language/Hearing Specialist/Technologist
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License Number |
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License Number State | VA
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Taxonomy #10
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Taxonomy Code | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State | VA
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Taxonomy #12
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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Taxonomy #13
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #14
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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Taxonomy #15
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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