Provider Demographics
NPI:1871208694
Name:EXCELLENCE IN MOTION PT AND PERFORMANCE LLC
Entity type:Organization
Organization Name:EXCELLENCE IN MOTION PT AND PERFORMANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:WILT
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:256-683-7364
Mailing Address - Street 1:7310 SANCTUARY COVE DR SE
Mailing Address - Street 2:
Mailing Address - City:OWENS CROSS ROADS
Mailing Address - State:AL
Mailing Address - Zip Code:35763-8872
Mailing Address - Country:US
Mailing Address - Phone:256-683-7364
Mailing Address - Fax:
Practice Address - Street 1:5534 HIGHWAY 431 S
Practice Address - Street 2:
Practice Address - City:BROWNSBORO
Practice Address - State:AL
Practice Address - Zip Code:35741-9771
Practice Address - Country:US
Practice Address - Phone:256-683-7364
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy