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	261QP2000X	Physical Therapy Clinic/Center	PT006697	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932537602
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EXCEL PHYSICAL THERAPY INC.

Provider Business Mailing Address
First Line	:	7735 STATE ROUTE 45
Second Line	:	P.O. BOX 366
City	:	LISBON
State	:	OH
Zip	:	44432-8342
Country	:	US
Telephone Number	:	330-424-9033
Fax Number	:	330-424-9053

Provider Business Practice Location Address
First Line	:	40 PARK DR
Second Line	:
City	:	EAST PALESTINE
State	:	OH
Zip	:	44413-1850
Country	:	US
Telephone Number	:	330-424-9033
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	MR. GEORGE ALAN SUMMERS
Credential	:	PT, MPT, OCS, C-IDN
Telephone Number	:	330-868-4362

Provider Enumeration Date	:	10/16/2013
Last Update Date	:	10/16/2013

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