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General NPI Number Information
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NPI Number | 1952444812
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Entity Type | Organization
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Legal Business Name | XCELERATE PHYSICAL THERAPY INC.
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 08/01/2022
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Provider Practice Location Address
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Address Line | 144 W LOS ANGELES AVE STE 110
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City | MOORPARK
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State | CA
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Zip | 93021-1898
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Country | US
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Telephone | 805-374-9900
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Fax | 805-374-9910
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Provider Business Mailing Address
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Address Line | 144 W LOS ANGELES AVE STE 110
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City | MOORPARK
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State | CA
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Zip | 93021-1898
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Country | US
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Telephone | 805-374-9900
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Fax | 805-374-9910
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Authorized Official
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Title or Position | PT
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Name | BRANDON DEDERICH
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Credential |
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Telephone | 805-552-1915
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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