Healthcare Provider Details

I. General information

NPI: 1396334462
Provider Name (Legal Business Name): XCEL PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2021
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 FALLS CREEK DR
VANDALIA OH
45377-8600
US

IV. Provider business mailing address

830 FALLS CREEK DR
VANDALIA OH
45377-8600
US

V. Phone/Fax

Practice location:
  • Phone: 937-890-9235
  • Fax:
Mailing address:
  • Phone: 937-890-9235
  • Fax: 937-890-9239

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: GREG MACKENZIE
Title or Position: CEO/MEMBER
Credential:
Phone: 937-470-3007