NPIMap

Organization Active NPI

Superior Physical Therapy

  • Physical Therapist
  • Pocatello, ID
National Provider Identifier
1265844062
Registry record updated Jun 9, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT-3602 Issued in ID
Legal business name
SUPERIOR PHYSICAL THERAPY
Practice address
1800 Flandro Dr Ste 190
Pocatello, ID 83202-4940
Phone
(208) 233-2248
Fax
(208) 233-0219
NPI assigned
May 28, 2014
Last updated
Jun 9, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Emilie L Peterson, DPTNPI 1588065882
Title
Physical Therapist
Phone
(208) 570-3636

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT-3602 ID Primary

Addresses

Primary practice location

1800 Flandro Dr Ste 190
Pocatello, ID 83202-4940

Mailing address

1800 Flandro Dr Ste 190
Pocatello, ID 83202-4940
Phone (208) 233-2248

National Provider Directory

National Provider Directory
Tax ID family
McDonald Rehab PC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1401235200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1402272000000",
    "number": "1265844062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 FLANDRO DR STE 190",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832024940",
            "telephone_number": "208-233-2248",
            "fax_number": "208-233-0219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 FLANDRO DR STE 190",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832024940",
            "telephone_number": "208-233-2248",
            "fax_number": "208-233-0219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPERIOR PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-28",
        "last_updated": "2014-06-09",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "EMILIE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "208-570-3636",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ID",
            "license": "PT-3602",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pocatello, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.