Provider Demographics
NPI:1760773501
Name:EXCEL PHYSICAL THERAPY
Entity Type:Organization
Organization Name:EXCEL PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:S
Authorized Official - Last Name:DECKER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:814-827-8148
Mailing Address - Street 1:PO BOX 286
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:PA
Mailing Address - Zip Code:16346-0286
Mailing Address - Country:US
Mailing Address - Phone:814-670-0534
Mailing Address - Fax:814-670-0653
Practice Address - Street 1:3236 STATE HWY 257, SUITE 1
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:PA
Practice Address - Zip Code:16346-0286
Practice Address - Country:US
Practice Address - Phone:814-670-0534
Practice Address - Fax:814-670-0653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-27
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT012509L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA002644580OtherHIGHMARK BLUE SHIELD