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General NPI Number Information
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NPI Number | 1770213811
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Entity Type | Organization
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Legal Business Name | SUPERKIDS PT LLC
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Dates
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Enumeration Date | 06/13/2022
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Last Update Date | 06/13/2022
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Provider Practice Location Address
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Address Line | 4701 BAPTIST RD STE 214A
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City | PITTSBURGH
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State | PA
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Zip | 15227-1176
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Country | US
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Telephone | 412-334-4790
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Fax | 412-365-5614
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Provider Business Mailing Address
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Address Line | 4701 BAPTIST RD STE 214A
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City | PITTSBURGH
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State | PA
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Zip | 15227-1176
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Country | US
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Telephone | 412-334-4790
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Fax | 412-365-5614
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Authorized Official
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Title or Position | PT
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Name | DR. KRISTIN CAMILLE LODICO
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Credential | DPT
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Telephone | 412-334-4790
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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