Healthcare Provider Details

I. General information

NPI: 1497848287
Provider Name (Legal Business Name): XCEL ORTHOPEDIC & SPORTS PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 E 6TH ST SUITE A-4
BEAUMONT CA
92223-2340
US

IV. Provider business mailing address

851 E 6TH ST SUITE A-4
BEAUMONT CA
92223-2340
US

V. Phone/Fax

Practice location:
  • Phone: 951-769-8555
  • Fax: 951-769-1220
Mailing address:
  • Phone: 951-769-8555
  • Fax: 951-769-1220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT 27975
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT 26569
License Number StateCA

VIII. Authorized Official

Name: BLAIR ALAN BAKER
Title or Position: OWNER
Credential: M.P.T.
Phone: 951-769-8555