Provider Demographics
NPI:1700503695
Name:SUPER BROTHER LLC
Entity Type:Organization
Organization Name:SUPER BROTHER LLC
Other - Org Name:TJ FOOT SPA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LIN
Authorized Official - Middle Name:
Authorized Official - Last Name:YUAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-360-5039
Mailing Address - Street 1:5402 BROADWAY ST STE 122
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-3749
Mailing Address - Country:US
Mailing Address - Phone:832-672-4776
Mailing Address - Fax:
Practice Address - Street 1:5402 BROADWAY ST STE 122
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-3749
Practice Address - Country:US
Practice Address - Phone:832-672-4776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-21
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No173C00000XOther Service ProvidersReflexologistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery CareGroup - Multi-Specialty