Provider Demographics
NPI:1952444812
Name:XCELERATE PHYSICAL THERAPY INC.
Entity Type:Organization
Organization Name:XCELERATE PHYSICAL THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:DEDERICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-552-1915
Mailing Address - Street 1:144 W LOS ANGELES AVE
Mailing Address - Street 2:STE 110
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-1898
Mailing Address - Country:US
Mailing Address - Phone:805-374-9900
Mailing Address - Fax:805-374-9910
Practice Address - Street 1:144 W LOS ANGELES AVE
Practice Address - Street 2:STE 110
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-1898
Practice Address - Country:US
Practice Address - Phone:805-374-9900
Practice Address - Fax:805-374-9910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA264440100OtherDEPT. OF LABOR
CAZZZ67264OtherBLUE SHIELD