MEDICARE: EXCEL PHYSICAL THERAPY INC

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
1	225100000X	Physical Therapist	2776	MN

General Provider Information

NPI Number	:	1104822717
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXCEL PHYSICAL THERAPY INC

Provider Business Mailing Address
First Line	:	300 CATLIN ST
Second Line	:	SUITE 100
City	:	BUFFALO
State	:	MN
Zip	:	55313-2001
Country	:	US
Telephone Number	:	763-682-2202
Fax Number	:	763-682-2439

Provider Business Practice Location Address
First Line	:	300 CATLIN ST
Second Line	:	SUITE 100
City	:	BUFFALO
State	:	MN
Zip	:	55313-2001
Country	:	US
Telephone Number	:	763-682-2202
Fax Number	:	763-682-2439

Authorized Official
Title or Position	:	PHYSICAL THERAPIST OWNER
Name	:	VIRGIL J MICHAELIS JR.
Credential	:	PT
Telephone Number	:	763-682-2202

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	08/22/2020

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Directions to “EXCEL PHYSICAL THERAPY INC ” Practice Location

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