Provider Demographics
NPI:1700912276
Name:EXCEED PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:EXCEED PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHAY
Authorized Official - Middle Name:
Authorized Official - Last Name:WINTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-727-2722
Mailing Address - Street 1:120 SOUTH JOHNSON STREET
Mailing Address - Street 2:
Mailing Address - City:KAHOKA
Mailing Address - State:MO
Mailing Address - Zip Code:63445
Mailing Address - Country:US
Mailing Address - Phone:660-727-2722
Mailing Address - Fax:660-727-2725
Practice Address - Street 1:120 SOUTH JOHNSON STREET
Practice Address - Street 2:
Practice Address - City:KAHOKA
Practice Address - State:MO
Practice Address - Zip Code:63445
Practice Address - Country:US
Practice Address - Phone:660-727-2722
Practice Address - Fax:660-727-2725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO117019225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty