Healthcare Provider Details

I. General information

NPI: 1003273897
Provider Name (Legal Business Name): XCEL REHAB, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2016
Last Update Date: 02/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 RIVERWIND EAST, SUITE B
PEARL MS
39208
US

IV. Provider business mailing address

209 RIVERWIND E, SUITE B
PEARL MS
39208
US

V. Phone/Fax

Practice location:
  • Phone: 601-383-1247
  • Fax:
Mailing address:
  • Phone: 601-383-1247
  • 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: MR. CHRISTOPHER ROGERS
Title or Position: OWNER
Credential: LPTA
Phone: 601-383-1247