NPIMap

Organization Active NPI

Xcelerate Physical Therapy Inc.

  • Physical Therapist
  • Thousand Oaks, CA
National Provider Identifier
1306814124
Registry record updated Aug 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
XCELERATE PHYSICAL THERAPY INC.
Practice address
3180 Willow LN Ste 104
Thousand Oaks, CA 91361-4979
Phone
(805) 374-9900
NPI assigned
Mar 8, 2006
Last updated
Aug 1, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Brandon DederichNPI 1912976853
Title
PT
Phone
(805) 552-1915

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X CA Primary

Addresses

Primary practice location

3180 Willow LN Ste 104
Thousand Oaks, CA 91361-4979

Mailing address

3262 E Thousand Oaks Blvd Ste 100
Thousand Oaks, CA 91362-3443

Other identifiers 2

IdentifierTypeStateIssuer
264440100OtherCADEPARTMENT OF LABOR
ZZZ082282OtherCABLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040707001113 CA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 4385621374 Receives reassigned benefits from 7 practitioners
Practice locations: Moorpark, CA; Thousand Oaks, CA; Seal Beach, CA

National Provider Directory

National Provider Directory
Tax ID family
Xcelerate Physical Therapy Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3262 E Thousand Oaks Blvd
Ste 100
Thousand Oaks, CA 91362
Phone (805) 374-9900

3366 E Thousand Oaks Blvd
Fl 2
Thousand Oaks, CA 91362
Phone (805) 374-9900

3366 E Thousand Oaks Blvd
#2
Westlake Village, CA 91362
Phone (805) 374-9900

Practitioners & affiliated clinicians

Practitioners 34

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 34

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1141776000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1659312000000",
    "number": "1306814124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3262 E THOUSAND OAKS BLVD STE 100",
            "city": "THOUSAND OAKS",
            "state": "CA",
            "postal_code": "913623443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3180 WILLOW LN STE 104",
            "city": "THOUSAND OAKS",
            "state": "CA",
            "postal_code": "913614979",
            "telephone_number": "805-374-9900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "XCELERATE PHYSICAL THERAPY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-08",
        "last_updated": "2022-08-01",
        "certification_date": "2022-08-01",
        "status": "A",
        "authorized_official_last_name": "DEDERICH",
        "authorized_official_first_name": "BRANDON",
        "authorized_official_title_or_position": "PT",
        "authorized_official_telephone_number": "805-552-1915"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPARTMENT OF LABOR",
            "identifier": "264440100",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ082282",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Thousand Oaks, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.