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Organization
XCELERATE PHYSICAL THERAPY INC.
Active
Organization
XCELERATE PHYSICAL THERAPY INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRANDON DEDERICH (PT)
(805) 552-1915
Entity
Organization
Contact information
Practice address
3180 WILLOW LN STE 104, THOUSAND OAKS, CA 91361-4979
(805) 374-9900
Mailing address
3262 E THOUSAND OAKS BLVD STE 100, THOUSAND OAKS, CA 91362-3443
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
264440100
DEPARTMENT OF LABOR
CA
01
—
ZZZ082282
BLUE SHIELD
CA
Enumeration date
03/08/2006
Last updated
08/01/2022
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