Provider Demographics
NPI:1821004631
Name:EXCEL THERAPY SPECIALISTS, LLC
Entity Type:Organization
Organization Name:EXCEL THERAPY SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:T
Authorized Official - Last Name:MINNICK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:918-259-9522
Mailing Address - Street 1:2232 W HOUSTON ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-3529
Mailing Address - Country:US
Mailing Address - Phone:918-259-9522
Mailing Address - Fax:918-259-9521
Practice Address - Street 1:2232 W HOUSTON ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-3529
Practice Address - Country:US
Practice Address - Phone:918-259-9522
Practice Address - Fax:918-259-9521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK5825550004Medicare NSC
OK400522319Medicare PIN