Provider Demographics
NPI:1053600486
Name:EXCEL THERAPY SPECIALISTS
Entity type:Organization
Organization Name:EXCEL THERAPY SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGED CARE
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:WAGONER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-259-9522
Mailing Address - Street 1:2232 W HOUSTON ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-3529
Mailing Address - Country:US
Mailing Address - Phone:918-259-9522
Mailing Address - Fax:918-259-9521
Practice Address - Street 1:5110 S YALE
Practice Address - Street 2:SUITE 304
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135
Practice Address - Country:US
Practice Address - Phone:918-259-9522
Practice Address - Fax:918-259-9521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
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
OK400522319Medicare PIN