=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912131087
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EXCELSIOR PHYSICAL THERAPY & REHABILITATION, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/05/2009
-----------------------------------------------------
Last Update Date | 07/28/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 77 TARRYTOWN RD
-----------------------------------------------------
City | WHITE PLAINS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10607-1639
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-328-0717
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 77 TARRYTOWN ROAD
-----------------------------------------------------
City | WHITE PLAINS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10607-1664
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-328-0717
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PT STAFF
-----------------------------------------------------
Name | MS. JOSEPHINE S. DOLERA
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 914-328-0717
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------