Healthcare Provider Details

I. General information

NPI: 1750533246
Provider Name (Legal Business Name): XCEL PHYSICAL THERAPY, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2008
Last Update Date: 03/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 S STRAITS HWY
INDIAN RIVER MI
49749
US

IV. Provider business mailing address

P.O. BOX 829 351 S STRAITS HWY
INDIAN RIVER MI
49749
US

V. Phone/Fax

Practice location:
  • Phone: 231-238-2302
  • Fax: 231-238-2303
Mailing address:
  • Phone: 231-238-2302
  • Fax: 231-238-2303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN LAWRENCE KOLLY
Title or Position: OWNER, PHYSICAL THER
Credential: PT
Phone: 231-238-2302