Provider Demographics
NPI:1558637371
Name:EXCEL PHYSICAL THERAPY & REHABILITATION LLC
Entity Type:Organization
Organization Name:EXCEL PHYSICAL THERAPY & REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANUPA
Authorized Official - Middle Name:JOBOY
Authorized Official - Last Name:JACOB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-320-0125
Mailing Address - Street 1:320 BOLTON ST
Mailing Address - Street 2:SUITE- G2
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-3988
Mailing Address - Country:US
Mailing Address - Phone:508-624-0431
Mailing Address - Fax:
Practice Address - Street 1:320 BOLTON ST
Practice Address - Street 2:SUITE- G2
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-3988
Practice Address - Country:US
Practice Address - Phone:508-624-0431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16359225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty