Provider Demographics
NPI:1053508978
Name:XCEL PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:XCEL PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:G
Authorized Official - Last Name:GOLDBECK
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, ATC, CSCS, STC
Authorized Official - Phone:608-279-6960
Mailing Address - Street 1:621 W RACINE ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:WI
Mailing Address - Zip Code:53549-1048
Mailing Address - Country:US
Mailing Address - Phone:608-279-6960
Mailing Address - Fax:866-401-0083
Practice Address - Street 1:621 W RACINE ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:WI
Practice Address - Zip Code:53549-1048
Practice Address - Country:US
Practice Address - Phone:608-279-6960
Practice Address - Fax:866-401-0083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6214-024261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy