Provider Demographics
NPI:1881833903
Name:SUPERIOR PHYSICAL THERAPY
Entity Type:Organization
Organization Name:SUPERIOR PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERIPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:MCDONALD
Authorized Official - Last Name:MCEWAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-841-5555
Mailing Address - Street 1:206 S MINNESOTA ST
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89703-4267
Mailing Address - Country:US
Mailing Address - Phone:775-841-5555
Mailing Address - Fax:775-841-5563
Practice Address - Street 1:206 S MINNESOTA ST
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-4267
Practice Address - Country:US
Practice Address - Phone:775-841-5555
Practice Address - Fax:775-841-5563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1041174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty