Provider Demographics
NPI:1982045001
Name:SUPERIOR ACTIVE PARTNERS LLC
Entity Type:Organization
Organization Name:SUPERIOR ACTIVE PARTNERS LLC
Other - Org Name:ACTIVE PHYSICAL THERAPY - ISHPEMING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:HARTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1906-869-4343
Mailing Address - Street 1:820 CARP RIVER LN
Mailing Address - Street 2:STE 2
Mailing Address - City:ISHPEMING
Mailing Address - State:MI
Mailing Address - Zip Code:49849-3187
Mailing Address - Country:US
Mailing Address - Phone:906-869-4343
Mailing Address - Fax:
Practice Address - Street 1:820 CARP RIVER LN
Practice Address - Street 2:STE 2
Practice Address - City:ISHPEMING
Practice Address - State:MI
Practice Address - Zip Code:49849-3187
Practice Address - Country:US
Practice Address - Phone:906-869-4343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-17
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501009086261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy