Healthcare Provider Details

I. General information

NPI: 1841169422
Provider Name (Legal Business Name): XCEED PHYSICAL THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2025
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 DODGE AVE
EVANSTON IL
60201-4032
US

IV. Provider business mailing address

2625 N CLARK ST APT 1403
CHICAGO IL
60614-1860
US

V. Phone/Fax

Practice location:
  • Phone: 702-540-5441
  • Fax:
Mailing address:
  • Phone: 702-540-5441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LAUREN CARTER
Title or Position: MANAGING MEMBER
Credential: PT, DPT
Phone: 702-540-5441