Provider Demographics
NPI:1982708012
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 PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:802-893-7427
Mailing Address - Street 1:PO BOX 776
Mailing Address - Street 2:184 ROUTE 7 SOUTH
Mailing Address - City:MILTON
Mailing Address - State:VT
Mailing Address - Zip Code:05468-0776
Mailing Address - Country:US
Mailing Address - Phone:802-893-7427
Mailing Address - Fax:802-893-7429
Practice Address - Street 1:184 ROUTE 7 SOUTH
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:VT
Practice Address - Zip Code:05468-0776
Practice Address - Country:US
Practice Address - Phone:802-893-7427
Practice Address - Fax:802-893-7429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1006990Medicaid
VT00028711OtherBLUE CROSS BLUE SHIELD
VTVN2836Medicare PIN