Provider Demographics
NPI:1770213811
Name:SUPERKIDS PT LLC
Entity Type:Organization
Organization Name:SUPERKIDS PT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:CAMILLE
Authorized Official - Last Name:LODICO
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:412-334-4790
Mailing Address - Street 1:4701 BAPTIST RD STE 214A
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15227-1176
Mailing Address - Country:US
Mailing Address - Phone:412-334-4790
Mailing Address - Fax:412-365-5614
Practice Address - Street 1:4701 BAPTIST RD STE 214A
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15227-1176
Practice Address - Country:US
Practice Address - Phone:412-334-4790
Practice Address - Fax:412-365-5614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy