Active NPI
Excel Physical Therapy LLC
- Physical Therapy Clinic/Center
- Oshkosh, WI
National Provider Identifier
1295972024
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Clinic/Center
- Legal business name
- EXCEL PHYSICAL THERAPY LLC
- Practice address
- 480 N Koeller St
Oshkosh, WI 54902-4111 - Phone
- (920) 233-8739
- Fax
- (920) 233-8732
- NPI assigned
- Jan 15, 2009
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Kim Sue Gonia
- Title
- Office Manager
- Phone
- (920) 233-8739
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Clinic/Center | 261QP2000X | Primary |
Addresses
Primary practice location
480 N Koeller St
Oshkosh, WI 54902-4111
Mailing address
480 N Koeller St
Oshkosh, WI 54902-4111
Phone (920) 233-8739
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 40420300 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090305000476 | WI | Part B Supplier - Clinic/Group Practice | 1850457417 |
Receives reassigned benefits from 8 practitioners Practice locations: Appleton, WI; Oshkosh, WI |
National Provider Directory
National Provider DirectoryLocations
924 N Westhill Blvd
Appleton, WI 54914
Phone (920) 233-8739
480 N Koeller St
Oshkosh, WI 54902
Phone (920) 233-8739
Practitioners & affiliated clinicians
Practitioners 8
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1231977600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1366848000000",
"number": "1295972024",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "480 N KOELLER ST",
"city": "OSHKOSH",
"state": "WI",
"postal_code": "549024111",
"telephone_number": "920-233-8739",
"fax_number": "920-233-8732"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "480 N KOELLER ST",
"city": "OSHKOSH",
"state": "WI",
"postal_code": "549024111",
"telephone_number": "920-233-8739",
"fax_number": "920-233-8732"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "EXCEL PHYSICAL THERAPY LLC",
"organizational_subpart": "NO",
"enumeration_date": "2009-01-15",
"last_updated": "2013-04-25",
"status": "A",
"authorized_official_last_name": "GONIA",
"authorized_official_first_name": "KIM",
"authorized_official_middle_name": "SUE",
"authorized_official_title_or_position": "OFFICE MANAGER",
"authorized_official_telephone_number": "920-233-8739",
"authorized_official_name_prefix": "Mrs."
},
"taxonomies": [
{
"code": "261QP2000X",
"taxonomy_group": "",
"desc": "Clinic/Center, Physical Therapy",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "40420300",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Oshkosh, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.