Excel PT, LLC

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

4415024 Issued in WI

Legal business name

EXCEL PT, LLC

Practice address

420 N Koeller St
Oshkosh, WI 54902-4111

Phone

(920) 233-8739

Fax

(920) 233-8732

NPI assigned

Aug 28, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Robert Runge, PT

Title

Owner

Phone

(920) 233-8739

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1251417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1251417600000",
    "number": "1306079991",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 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": "420 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 PT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-28",
        "last_updated": "2009-08-28",
        "status": "A",
        "authorized_official_last_name": "RUNGE",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "920-233-8739",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "4415024",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Douglas Evansen
• Evergreen Retirement Community, Inc.
• Evergreen Retirement Community, Inc.
• Marijo Evers
• Excel Physical Therapy LLC
• Eye Clinic of the Fox Valley SC
• Eye Clinic of the Fox Valley SC
• Eyemart Express LLC
• Wendy Sue Fabisiak
• Paul Anthony Fagan, D.O.

• All providers in Oshkosh, WI
• Physical Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.