Provider Demographics
NPI:1912023813
Name:EXCEL PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:EXCEL PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:SUMMERS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MPT, OCS, C-IDN
Authorized Official - Phone:330-424-9033
Mailing Address - Street 1:PO BOX 366
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:OH
Mailing Address - Zip Code:44432-0366
Mailing Address - Country:US
Mailing Address - Phone:330-424-9033
Mailing Address - Fax:330-424-9053
Practice Address - Street 1:7735 STATE ROUTE 45
Practice Address - Street 2:SUITE E
Practice Address - City:LISBON
Practice Address - State:OH
Practice Address - Zip Code:44432
Practice Address - Country:US
Practice Address - Phone:330-424-9033
Practice Address - Fax:330-424-9053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT6697225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2133588Medicaid
OH2133588Medicaid