Provider Demographics
NPI:1386671378
Name:XCELL ORTHOPAEDICS INSTITUTE OF SPORTS PERFORMANCE, LLC
Entity Type:Organization
Organization Name:XCELL ORTHOPAEDICS INSTITUTE OF SPORTS PERFORMANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:O
Authorized Official - Last Name:LEAL
Authorized Official - Suffix:
Authorized Official - Credentials:LPT
Authorized Official - Phone:956-686-2242
Mailing Address - Street 1:2001 S D ST
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1854
Mailing Address - Country:US
Mailing Address - Phone:956-686-2242
Mailing Address - Fax:956-686-3515
Practice Address - Street 1:2001 S D ST
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1854
Practice Address - Country:US
Practice Address - Phone:956-686-2242
Practice Address - Fax:956-686-3515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1139020225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171862901Medicaid
TX171863701Medicaid