Excel Physical Therapy Institute, LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

EXCEL PHYSICAL THERAPY INSTITUTE, LLC

Practice address

1212 S Air Depot Blvd
Suite 17
Midwest City, OK 73110-4870

Phone

(405) 455-3784

Fax

(405) 455-3844

NPI assigned

Apr 11, 2007

Last updated

Aug 22, 2020By 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

Dr. Shawn G Wallace, PT, DPT

Title

Owner - Partner

Phone

(405) 455-3784

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1176249600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1568685865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1212 S AIR DEPOT BLVD",
            "address_2": "SUITE 17",
            "city": "MIDWEST CITY",
            "state": "OK",
            "postal_code": "731104870",
            "telephone_number": "405-455-3784",
            "fax_number": "405-455-3844"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1212 S AIR DEPOT BLVD",
            "address_2": "SUITE 17",
            "city": "MIDWEST CITY",
            "state": "OK",
            "postal_code": "731104870",
            "telephone_number": "405-455-3784",
            "fax_number": "405-455-3844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXCEL PHYSICAL THERAPY INSTITUTE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "SHAWN",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER - PARTNER",
        "authorized_official_telephone_number": "405-455-3784",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PT, DPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "OK",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapy Clinic/Center in Midwest City, OK
• Providers in Midwest City, OK by specialty
• Physical Therapy Clinic/Center in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.