1952444812 NPI number — XCELERATE PHYSICAL THERAPY INC.

Table of content: (NPI 1952444812)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952444812 NPI number — XCELERATE PHYSICAL THERAPY INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
XCELERATE PHYSICAL THERAPY INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952444812
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
144 W LOS ANGELES AVE
Provider Second Line Business Mailing Address:
STE 110
Provider Business Mailing Address City Name:
MOORPARK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93021-1898
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-374-9900
Provider Business Mailing Address Fax Number:
805-374-9910

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
144 W LOS ANGELES AVE
Provider Second Line Business Practice Location Address:
STE 110
Provider Business Practice Location Address City Name:
MOORPARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93021-1898
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-374-9900
Provider Business Practice Location Address Fax Number:
805-374-9910
Provider Enumeration Date:
02/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DEDERICH
Authorized Official First Name:
BRANDON
Authorized Official Middle Name:
Authorized Official Title or Position:
PT
Authorized Official Telephone Number:
805-552-1915

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 264440100 . This is a "DEPT. OF LABOR" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: ZZZ67264 . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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