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General NPI Number Information
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NPI Number | 1174066120
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Entity Type | Organization
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Legal Business Name | EXCEL SPINE AND SPORTS REHAB PC
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Dates
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Enumeration Date | 11/23/2016
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Last Update Date | 07/30/2025
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Provider Practice Location Address
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Address Line | 3901 MAIN ST STE 10
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City | ROWLETT
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State | TX
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Zip | 75088-5171
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Country | US
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Telephone | 469-443-0458
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Fax | 469-573-6918
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Provider Business Mailing Address
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Address Line | 3901 MAIN ST STE 10
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City | ROWLETT
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State | TX
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Zip | 75088-5171
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Country | US
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Telephone | 469-443-0458
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Fax | 469-573-6918
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Authorized Official
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Title or Position | CEO/ PRESIDENT
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Name | RANDY VILLARD
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Credential | PT
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Telephone | 469-865-7297
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 1124683
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License Number State | TX
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