Excel Physical Therapy & Sports Medicine Clinic
Organization Active NPI Physical Therapist · Boonville, MO
NPI 1609930593 · NPPES record last updated Oct 16, 2007
Key facts
- NPI
- 1609930593
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Therapist 225100000X
- License
- 108639 (MO)
- Legal business name
- EXCEL PHYSICAL THERAPY & SPORTS MEDICINE CLINIC
- Practice address
- 1420 W Ashley Rd
Boonville, MO 65233-2112 - Phone
- (660) 882-6115
- Fax
- (660) 882-6120
- NPI assigned
- Dec 21, 2006
- Organization subpart
- No
Authorized official
- Name
- Jill S McCormick, P.T., A.T.C.
- Title
- Owner
- Phone
- (773) 892-7501
Practitioners 1
-
Jill Suzanne McCormick, P.T.
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist |
225100000X | 108639 | MO | Yes |
Addresses
Primary practice location
1420 W Ashley Rd
Boonville, MO 65233-2112
Mailing address
1420 W Ashley Rd
Boonville, MO 65233-2112
Phone (660) 882-6115
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 122566 | Other | BLUE CROSS BLUE SHEILD | |
| DA1611 | Other | MO | MEDICARE RAILROAD |
Other providers in Boonville, MO
- Andrew Dotzler
- Elise Welsh DNP, LLC
- Sally J Ellebracht-Gerke
- Brittney Fay Ellington
- Eric Elliott
- Eyecare of Boonville, LLC
- Family Counseling Center of Missouri, Inc.
- John Douglas Foster II
- Lyndi Geha
- Elyssa Ann Gibbons
All providers in Boonville, MO · Physical Therapist in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 16, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.