Provider Demographics
NPI:1013487677
Name:SUPERIOR WOUND CARE AND PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:SUPERIOR WOUND CARE AND PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:J
Authorized Official - Last Name:LUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:949-646-0653
Mailing Address - Street 1:1441 SUPERIOR AVE STE D
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-2700
Mailing Address - Country:US
Mailing Address - Phone:949-646-0653
Mailing Address - Fax:949-646-9228
Practice Address - Street 1:1441 SUPERIOR AVE STE D
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-2700
Practice Address - Country:US
Practice Address - Phone:949-646-0653
Practice Address - Fax:949-646-9228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty