Provider Demographics
NPI:1912131087
Name:EXCELSIOR PHYSICAL THERAPY & REHABILITATION, PLLC
Entity Type:Organization
Organization Name:EXCELSIOR PHYSICAL THERAPY & REHABILITATION, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT STAFF
Authorized Official - Prefix:MS
Authorized Official - First Name:JOSEPHINE
Authorized Official - Middle Name:S
Authorized Official - Last Name:DOLERA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:914-328-0717
Mailing Address - Street 1:77 TARRYTOWN ROAD
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10607-1664
Mailing Address - Country:US
Mailing Address - Phone:914-328-0717
Mailing Address - Fax:
Practice Address - Street 1:77 TARRYTOWN RD
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10607-1639
Practice Address - Country:US
Practice Address - Phone:914-328-0717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-05
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center