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General NPI Number Information
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NPI Number | 1396138715
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Entity Type | Organization
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Legal Business Name | EXCEL PERFORMANCE PHYSICAL THERAPY, P.C.
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Dates
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Enumeration Date | 03/10/2015
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Last Update Date | 03/10/2015
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Provider Practice Location Address
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Address Line | 2650 RESEARCH PARK DR
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City | SOQUEL
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State | CA
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Zip | 95073-2087
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Country | US
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Telephone | 831-566-2004
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Fax | 831-325-0307
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Provider Business Mailing Address
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Address Line | 121 WAUGH AVE
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City | SANTA CRUZ
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State | CA
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Zip | 95065-1133
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Country | US
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Telephone | 831-566-2004
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Fax | 831-325-0307
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Authorized Official
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Title or Position | OWNER
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Name | JILL MCCORMICK
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Credential | P.T.
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Telephone | 831-566-2004
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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 | 36994
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License Number State | CA
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