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NPI Code Detail

MEDICARE: EXCEL REHABILITATION SERVICES, LLC

MEDICARE: EXCEL REHABILITATION SERVICES, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist04493LA

General Provider Information

NPI Number : 1093088098
Entity Type Code : Organization
Provider Name (Legal Business Name) : EXCEL REHABILITATION SERVICES, LLC
Provider Business Mailing Address
First Line : 2251 S BURNSIDE AVE
Second Line :
City : GONZALES
State : LA
Zip : 70737-4642
Country : US
Telephone Number : 225-644-0290
Fax Number : 225-644-4201
Provider Business Practice Location Address
First Line : 2251 S BURNSIDE AVE
Second Line :
City : GONZALES
State : LA
Zip : 70737-4642
Country : US
Telephone Number : 225-644-0290
Fax Number : 225-644-4201
Authorized Official
Title or Position : OWNER, PHYSICAL THERAPIST
Name : MR. DAVID MIRANDA
Credential : PT
Telephone Number : 225-644-0290
Provider Enumeration Date : 02/22/2012
Last Update Date : 07/31/2013

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Directions to “EXCEL REHABILITATION SERVICES, LLC ” Practice Location

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