Healthcare Provider Details

I. General information

NPI: 1306814124
Provider Name (Legal Business Name): XCELERATE PHYSICAL THERAPY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 08/01/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3180 WILLOW LN STE 104
THOUSAND OAKS CA
91361-4979
US

IV. Provider business mailing address

3262 E THOUSAND OAKS BLVD STE 100
THOUSAND OAKS CA
91362-3443
US

V. Phone/Fax

Practice location:
  • Phone: 805-374-9900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name: BRANDON DEDERICH
Title or Position: PT
Credential:
Phone: 805-552-1915