Provider Demographics
NPI:1780083980
Name:EXCEL THERAPY GROUP, INC.
Entity type:Organization
Organization Name:EXCEL THERAPY GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:RUEL
Authorized Official - Middle Name:WARRINER
Authorized Official - Last Name:ABIAD
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L, PAMS, SWC
Authorized Official - Phone:510-205-1642
Mailing Address - Street 1:PO BOX 5215
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94948-5215
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:415-223-9513
Practice Address - Street 1:6469 EAGLE RIDGE DR
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94591-6325
Practice Address - Country:US
Practice Address - Phone:510-205-1642
Practice Address - Fax:415-223-9513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 8343225X00000X
CAPT 28065208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty