Provider Demographics
NPI:1295823110
Name:X-CEL ENTERPRISES, INC.
Entity Type:Organization
Organization Name:X-CEL ENTERPRISES, INC.
Other - Org Name:PHYSIOCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:N
Authorized Official - Last Name:WHITEHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:PTA
Authorized Official - Phone:206-979-8248
Mailing Address - Street 1:328 S STILLAGUAMISH AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-1660
Mailing Address - Country:US
Mailing Address - Phone:360-474-8686
Mailing Address - Fax:360-474-0246
Practice Address - Street 1:17191 BOTHELL WAY NE
Practice Address - Street 2:SUITE B203
Practice Address - City:LAKE FOREST PARK
Practice Address - State:WA
Practice Address - Zip Code:98155
Practice Address - Country:US
Practice Address - Phone:206-367-6069
Practice Address - Fax:206-367-6319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7114713Medicaid
WA0167362OtherL&I
WA0167362OtherL&I