Provider Demographics
NPI:1275905689
Name:SUPERIOR PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:SUPERIOR PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:GARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:402-879-0109
Mailing Address - Street 1:PO BOX 263
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:NE
Mailing Address - Zip Code:68978-0263
Mailing Address - Country:US
Mailing Address - Phone:402-879-1267
Mailing Address - Fax:866-764-0606
Practice Address - Street 1:308 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:NE
Practice Address - Zip Code:68978-1715
Practice Address - Country:US
Practice Address - Phone:402-879-0109
Practice Address - Fax:866-764-0606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-25
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1484261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy