Basic Information
| Provider Information | |||||||||
| NPI: | 1336438761 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EXCEL THERAPY SPECIALISTS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2232 W HOUSTON ST | ||||||||
| Address2: | |||||||||
| City: | BROKEN ARROW | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740123529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9182599522 | ||||||||
| FaxNumber: | 9182599521 | ||||||||
| Practice Location | |||||||||
| Address1: | 409 DAISY DRIVE | ||||||||
| Address2: | STE F-2 | ||||||||
| City: | TAHLEQUAH | ||||||||
| State: | OK | ||||||||
| PostalCode: | 74464 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184589235 | ||||||||
| FaxNumber: | 9184589236 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2011 | ||||||||
| LastUpdateDate: | 04/06/2011 | ||||||||
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| AuthorizedOfficialLastName: | WAGONER | ||||||||
| AuthorizedOfficialFirstName: | JANICE | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGED CARE | ||||||||
| AuthorizedOfficialTelephone: | 9182599522 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.