MEDICARE: EXCLUSIVE 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

General Provider Information

NPI Number	:	1275570186
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXCLUSIVE PHYSICAL THERAPY INC

Provider Business Mailing Address
First Line	:	416 S CREYTS RD
Second Line	:	SUITE B
City	:	LANSING
State	:	MI
Zip	:	48917-8290
Country	:	US
Telephone Number	:	517-327-0966
Fax Number	:	517-327-0986

Provider Business Practice Location Address
First Line	:	416 S CREYTS RD
Second Line	:	SUITE B
City	:	LANSING
State	:	MI
Zip	:	48917-8290
Country	:	US
Telephone Number	:	517-327-0966
Fax Number	:	517-327-0986

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. SCOTT BENJAMIN
Credential	:	PT
Telephone Number	:	517-327-0966

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	11/17/2009

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