Provider Demographics
NPI:1740322304
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
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:OBERGOTTSBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:360-734-2277
Mailing Address - Street 1:4029 NORTHWEST AVE
Mailing Address - Street 2:SUITE #302
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-9077
Mailing Address - Country:US
Mailing Address - Phone:360-734-2277
Mailing Address - Fax:360-734-3006
Practice Address - Street 1:4029 NORTHWEST AVE
Practice Address - Street 2:SUITE #302
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-9077
Practice Address - Country:US
Practice Address - Phone:360-734-2277
Practice Address - Fax:360-734-3006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00006753261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7128838Medicaid
WAG8854808Medicare PIN