Provider Demographics
NPI:1568778876
Name:SUPERIOR MEDICAL&REHAB CENTER
Entity Type:Organization
Organization Name:SUPERIOR MEDICAL&REHAB CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRATIC
Authorized Official - Prefix:
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:727-869-4999
Mailing Address - Street 1:11911 OAK TRAIL WAY
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-1064
Mailing Address - Country:US
Mailing Address - Phone:727-869-4999
Mailing Address - Fax:727-869-4995
Practice Address - Street 1:11911 OAK TRAIL WAY
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-1064
Practice Address - Country:US
Practice Address - Phone:727-869-4999
Practice Address - Fax:727-869-4995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH5539261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy