Provider Demographics
NPI:1972092179
Name:SUPERIOR PHYSICAL THERAPY
Entity type:Organization
Organization Name:SUPERIOR PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:YASSER
Authorized Official - Middle Name:
Authorized Official - Last Name:SOUHOUBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-996-8158
Mailing Address - Street 1:27209 LAHSER RD STE 130
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-8401
Mailing Address - Country:US
Mailing Address - Phone:248-996-8158
Mailing Address - Fax:248-281-6339
Practice Address - Street 1:27209 LAHSER RD STE 130
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-8401
Practice Address - Country:US
Practice Address - Phone:248-996-8158
Practice Address - Fax:248-281-6339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-03
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy