Provider Demographics
NPI:1265482954
Name:EXCEL PHYSICAL THERAPY & WELLNESS, PC
Entity Type:Organization
Organization Name:EXCEL PHYSICAL THERAPY & WELLNESS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:LAZARO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:845-292-0890
Mailing Address - Street 1:111 SULLIVAN AVE
Mailing Address - Street 2:SUITE 1-6
Mailing Address - City:FERNDALE
Mailing Address - State:NY
Mailing Address - Zip Code:12734-4315
Mailing Address - Country:US
Mailing Address - Phone:845-292-0890
Mailing Address - Fax:845-292-0940
Practice Address - Street 1:111 SULLIVAN AVE
Practice Address - Street 2:SUITE 1-6
Practice Address - City:FERNDALE
Practice Address - State:NY
Practice Address - Zip Code:12734-4315
Practice Address - Country:US
Practice Address - Phone:845-292-0890
Practice Address - Fax:845-292-0940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022218225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty