Provider Demographics
NPI:1205021557
Name:EXCEL PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:EXCEL PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BASHOR
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:919-249-4040
Mailing Address - Street 1:1031 W WILLIAMS ST
Mailing Address - Street 2:STE. 103
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-3955
Mailing Address - Country:US
Mailing Address - Phone:919-249-4040
Mailing Address - Fax:919-249-4043
Practice Address - Street 1:1031 W WILLIAMS ST
Practice Address - Street 2:STE. 103
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-3955
Practice Address - Country:US
Practice Address - Phone:919-249-4040
Practice Address - Fax:919-249-4043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2505048Medicare PIN