MEDICARE: EXCEL PERFORMANCE AND MOBILITY LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	2251S0007X	Sports Physical Therapist
2	2255A2300X	Athletic Trainer
3	2251X0800X	Orthopedic Physical Therapist

General Provider Information

NPI Number	:	1669946968
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXCEL PERFORMANCE AND MOBILITY LLC

Provider Business Mailing Address
First Line	:	1348 SW 2ND CT
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-7593
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3400 SW 26TH TER
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-5068
Country	:	US
Telephone Number	:	954-530-2328
Fax Number	:

Authorized Official
Title or Position	:	OWNER, OPERATING MANAGER
Name	:	ELIZABETH KREYMER
Credential	:
Telephone Number	:	954-562-1333

Provider Enumeration Date	:	01/20/2019
Last Update Date	:	01/20/2019

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