Provider Demographics
NPI:1063695088
Name:SUPER PHYSICAL THERAPY, LLC
Entity type:Organization
Organization Name:SUPER PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SUPER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:484-951-2654
Mailing Address - Street 1:5472 FALCON CT
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-8211
Mailing Address - Country:US
Mailing Address - Phone:484-951-2654
Mailing Address - Fax:610-837-1693
Practice Address - Street 1:5472 FALCON CT
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-8211
Practice Address - Country:US
Practice Address - Phone:484-951-2654
Practice Address - Fax:610-837-1693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2023-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT009952L261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
265408OtherHIGHMARK BLUE SHIELD
718809OtherUNITED HEALTHCARE
50075511OtherCAPITAL BLUE CROSS
023243Medicare PIN