Provider Demographics
NPI:1497848287
Name:XCEL ORTHOPEDIC & SPORTS PHYSICAL THERAPY
Entity Type:Organization
Organization Name:XCEL ORTHOPEDIC & SPORTS PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BLAIR
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:951-769-8555
Mailing Address - Street 1:851 E 6TH ST
Mailing Address - Street 2:SUITE A-4
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-2340
Mailing Address - Country:US
Mailing Address - Phone:951-769-8555
Mailing Address - Fax:951-769-1220
Practice Address - Street 1:851 E 6TH ST
Practice Address - Street 2:SUITE A-4
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-2340
Practice Address - Country:US
Practice Address - Phone:951-769-8555
Practice Address - Fax:951-769-1220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 26569261QP2000X
CAPT 27975261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ04378ZMedicare PIN