Superior Physical Therapy LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

1484 Issued in NE

Legal business name

SUPERIOR PHYSICAL THERAPY LLC

Practice address

308 N Central Ave
Superior, NE 68978-1715

Phone

(402) 879-0109

Fax

(866) 764-0606

NPI assigned

Oct 25, 2015

Organization subpart

No

Name

Bradley J Gardner, MPTNPI 1821267550

Title

Sole Member

Phone

(402) 879-0109

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Bradley J Gardner, PT

  • Physical Therapist
  • Superior, NE
  • NPI 1821267550

  NE

  Medicare reassignment NPD Authorized official
• Holly Beavers, DPT

  • Physical Therapist
  • Belleville, KS
  • NPI 1568970739

  NE

  Medicare reassignment NPD
• Denise McClurg, CPTA

  • Physical Therapy Assistant
  • Superior, NE
  • NPI 1548092372
  NPD (past)

Medicare fee-for-service enrollment

Enrolled in NE

Enrollment records 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 7, 2020.

{
    "created_epoch": "1445731200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578355200000",
    "number": "1275905689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 263",
            "city": "SUPERIOR",
            "state": "NE",
            "postal_code": "689780263",
            "telephone_number": "402-879-1267",
            "fax_number": "866-764-0606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "308 N CENTRAL AVE",
            "city": "SUPERIOR",
            "state": "NE",
            "postal_code": "689781715",
            "telephone_number": "402-879-0109",
            "fax_number": "866-764-0606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPERIOR PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-25",
        "last_updated": "2020-01-07",
        "certification_date": "2020-01-07",
        "status": "A",
        "authorized_official_last_name": "GARDNER",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "402-879-0109",
        "authorized_official_credential": "MPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NE",
            "license": "1484",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stacy Lynne Souerdyke, PHARM D
• South Central Behavioral Services
• Jett Stenson, M.S., CCC-SLP
• Rebekka Stephens
• Superior Pharmacy, Inc.
• Superior Vision PC
• Stephanie Svoboda, D.D.S
• Teachworth Chiropractic LLC
• The Evangelical Lutheran Good Samaritan Society
• The Evangelical Lutheran Good Samaritan Society

• All providers in Superior, NE
• Physical Therapy Clinic/Center in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.