MEDICARE: SUPERIOR PHYSICAL THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	1041	NV

General Provider Information

NPI Number	:	1881833903
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPERIOR PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	206 S MINNESOTA ST
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89703-4267
Country	:	US
Telephone Number	:	775-841-5555
Fax Number	:	775-841-5563

Provider Business Practice Location Address
First Line	:	206 S MINNESOTA ST
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89703-4267
Country	:	US
Telephone Number	:	775-841-5555
Fax Number	:	775-841-5563

Authorized Official
Title or Position	:	PHYSICAL THERIPIST
Name	:	MR. CRAIG MCDONALD MCEWAN
Credential	:
Telephone Number	:	775-841-5555

Provider Enumeration Date	:	02/12/2009
Last Update Date	:	02/12/2009

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Directions to “SUPERIOR PHYSICAL THERAPY ” Practice Location

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