Provider Demographics
NPI:1255668323
Name:EXCEL PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:EXCEL PHYSICAL THERAPY, LLC
Other - Org Name:PHYSICAL REHABILITATION HOSPITAL GROUP, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:B
Authorized Official - Last Name:REEVES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:803-661-8522
Mailing Address - Street 1:810 MALLET HILL RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-4406
Mailing Address - Country:US
Mailing Address - Phone:803-661-8522
Mailing Address - Fax:803-419-6692
Practice Address - Street 1:810 MALLET HILL RD
Practice Address - Street 2:SUITE 2
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-4406
Practice Address - Country:US
Practice Address - Phone:803-661-8522
Practice Address - Fax:803-419-6692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-11
Last Update Date:2014-01-03
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
SC9422Medicare PIN