Healthcare Provider Details

I. General information

NPI: 1538462015
Provider Name (Legal Business Name): SUPERIOR HEALTH AND WELLNESS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2010
Last Update Date: 02/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 BLUFFTON RD STE D
BLUFFTON SC
29910-6226
US

IV. Provider business mailing address

163 BLUFFTON RD STE D
BLUFFTON SC
29910-6226
US

V. Phone/Fax

Practice location:
  • Phone: 843-247-3054
  • Fax:
Mailing address:
  • Phone: 843-247-3054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. BLAIR MARTIN
Title or Position: OWNER/PRESIDENT
Credential: D.C.
Phone: 843-247-3054