Provider Demographics
NPI:1184714719
Name:EXCEL REHABILITATION, LLC.
Entity type:Organization
Organization Name:EXCEL REHABILITATION, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUSTY
Authorized Official - Middle Name:G
Authorized Official - Last Name:BECKER
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:334-532-0220
Mailing Address - Street 1:399 MOUNTAIN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MILLBROOK
Mailing Address - State:AL
Mailing Address - Zip Code:36054-2128
Mailing Address - Country:US
Mailing Address - Phone:334-285-7101
Mailing Address - Fax:
Practice Address - Street 1:2125 E SOUTH BLVD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-2409
Practice Address - Country:US
Practice Address - Phone:334-532-0220
Practice Address - Fax:334-532-0221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2334225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529926860Medicaid
AL51524863OtherBCBS PRO NUMBER
AL529926860Medicaid