Provider Demographics
NPI:1912445552
Name:EXCELLENT THERAPY SERVICES PLLC
Entity Type:Organization
Organization Name:EXCELLENT THERAPY SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:YOUNAS
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:248-265-6722
Mailing Address - Street 1:1868 CONNOLLY DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-5328
Mailing Address - Country:US
Mailing Address - Phone:248-265-6722
Mailing Address - Fax:248-265-6722
Practice Address - Street 1:1868 CONNOLLY DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098-5328
Practice Address - Country:US
Practice Address - Phone:248-265-6722
Practice Address - Fax:248-265-6722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501003213261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy