Provider Demographics
NPI:1730127341
Name:XCEL SPORTS MEDICINE LLC
Entity Type:Organization
Organization Name:XCEL SPORTS MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/ VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALISTAIR
Authorized Official - Middle Name:GREGOR
Authorized Official - Last Name:MACKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PT
Authorized Official - Phone:937-890-9235
Mailing Address - Street 1:727 CROSSROADS CT
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:OH
Mailing Address - Zip Code:45377-9415
Mailing Address - Country:US
Mailing Address - Phone:937-890-9235
Mailing Address - Fax:
Practice Address - Street 1:727 CROSSROADS CT
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:OH
Practice Address - Zip Code:45377-9415
Practice Address - Country:US
Practice Address - Phone:937-890-9235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH10596261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy