| Organization Name: | SUPERIOR PHYSICAL THERAPY |
| NPI Number: | 1265844062 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | EMILIE L PETERSON (PHYSICAL THERAPIST) |
| Mailing Address: | 1800 Flandro Dr Ste 190 Pocatello |
| State: | ID US |
| Postal Code: | 832024940 |
| Phone Number: | 2082332248 |
| Fax Number: | 2082330219 |
| NPI Enumeration Date: | 05/28/2014 |
| NPI Last Update Date: | 06/09/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | PT-3602 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |