Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225000000X | Orthotic Fitter | OF000004 | PA |
NPI | 1982838496 |
---|---|
Provider Name | Robert Michael Super |
First Address | Pipersville, PA 18947 |
Second Address | Plano, TX 75075-7248 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2009 |
Last Update Date | 27/04/2014 |