Excel Physical Therapy and Sports Performance, LLC

Primary specialty

Rehabilitation Clinic/CenterTaxonomy code 261QR0400X

License

02111 Issued in WV

Legal business name

EXCEL PHYSICAL THERAPY AND SPORTS PERFORMANCE, LLC

Practice address

3540 Teays Valley Rd
Hurricane, WV 25526-9054

Phone

(304) 881-5042

Fax

(304) 562-7821

NPI assigned

Dec 10, 2013

Last updated

Jan 26, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Mark Edward Nichols, PT

Title

Physical Therapist/Owner

Phone

(304) 881-5042

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1386633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1453766400000",
    "number": "1437580834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3540 TEAYS VALLEY RD",
            "city": "HURRICANE",
            "state": "WV",
            "postal_code": "255269054",
            "telephone_number": "304-881-5042",
            "fax_number": "304-562-7821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3540 TEAYS VALLEY RD",
            "city": "HURRICANE",
            "state": "WV",
            "postal_code": "255269054",
            "telephone_number": "304-881-5042",
            "fax_number": "304-562-7821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXCEL PHYSICAL THERAPY AND SPORTS PERFORMANCE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-10",
        "last_updated": "2016-01-26",
        "status": "A",
        "authorized_official_last_name": "NICHOLS",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST/OWNER",
        "authorized_official_telephone_number": "304-881-5042",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": "WV",
            "license": "02111",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katie Taylor Ethridge, MOT, OTRL
• Wendy G Etzkorn, MSW LICSW
• Charles Evans II
• Pauline Denise Evans, LPN
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• Eye Associates, PLLC
• Lisa Rae Eye, PT
• Rachel Ashley Fairhurst, PA-C
• Faith in Motion Performance Therapy LLC (Faith In Motion)
• Earl Michael Tecson Famularcano, MD

• Rehabilitation Clinic/Center in Hurricane, WV
• Providers in Hurricane, WV by specialty
• Rehabilitation Clinic/Center in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2016; 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.