Provider Demographics
NPI:1487845202
Name:EXCEL PHYSICAL THERAPY
Entity Type:Organization
Organization Name:EXCEL PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:520-440-7860
Mailing Address - Street 1:980 S PAPERFLOWER AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85748-3536
Mailing Address - Country:US
Mailing Address - Phone:520-440-7860
Mailing Address - Fax:520-203-7659
Practice Address - Street 1:8701 S KOLB RD
Practice Address - Street 2:#7-202
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85756-9607
Practice Address - Country:US
Practice Address - Phone:520-440-7860
Practice Address - Fax:520-203-7659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4250261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ109367Medicare PIN
AZZ62984Medicare UPIN