Provider Demographics
NPI:1679109953
Name:EXCELLENCE PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:EXCELLENCE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RATI
Authorized Official - Middle Name:
Authorized Official - Last Name:PORIYA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:281-908-6480
Mailing Address - Street 1:2211 S HIGHWAY 77 STE 201
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-4641
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2211 S HIGHWAY 77 STE 201
Practice Address - Street 2:
Practice Address - City:LYNN HAVEN
Practice Address - State:FL
Practice Address - Zip Code:32444-4641
Practice Address - Country:US
Practice Address - Phone:850-252-1414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-18
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center