Provider Demographics
NPI:1275570186
Name:EXCLUSIVE PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:EXCLUSIVE PHYSICAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:BENJAMIN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:517-327-0966
Mailing Address - Street 1:416 S CREYTS RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-8290
Mailing Address - Country:US
Mailing Address - Phone:517-327-0966
Mailing Address - Fax:517-327-0986
Practice Address - Street 1:416 S CREYTS RD
Practice Address - Street 2:SUITE B
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-8290
Practice Address - Country:US
Practice Address - Phone:517-327-0966
Practice Address - Fax:517-327-0986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2009-11-17
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
MI0N84590Medicare PIN