Provider Demographics
NPI:1477877744
Name:EXCEL REHAB THERAPY LLC
Entity Type:Organization
Organization Name:EXCEL REHAB THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-243-6822
Mailing Address - Street 1:8142 S STATE ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MIDVALE
Mailing Address - State:UT
Mailing Address - Zip Code:84047-3210
Mailing Address - Country:US
Mailing Address - Phone:801-243-6822
Mailing Address - Fax:
Practice Address - Street 1:8142 S STATE ST
Practice Address - Street 2:SUITE 103
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-3210
Practice Address - Country:US
Practice Address - Phone:801-243-6822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-16
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT341753-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty