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General NPI Number Information
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NPI Number | 1881833903
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Entity Type | Organization
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Legal Business Name | SUPERIOR PHYSICAL THERAPY
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Dates
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Enumeration Date | 02/12/2009
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Last Update Date | 02/12/2009
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Provider Practice Location Address
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Address Line | 206 S MINNESOTA ST
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City | CARSON CITY
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State | NV
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Zip | 89703-4267
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Country | US
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Telephone | 775-841-5555
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Fax | 775-841-5563
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Provider Business Mailing Address
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Address Line | 206 S MINNESOTA ST
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City | CARSON CITY
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State | NV
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Zip | 89703-4267
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Country | US
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Telephone | 775-841-5555
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Fax | 775-841-5563
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Authorized Official
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Title or Position | PHYSICAL THERIPIST
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Name | MR. CRAIG MCDONALD MCEWAN
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Credential |
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Telephone | 775-841-5555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 1041
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License Number State | NV
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