# SUPERIOR SPINE AND SPORTS PHYSICAL THERAPY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** S3PT
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619681772
- **Authorized official:** KOURTNEY ELLIS DPT (CO-OWNER)
- **Authorized official phone:** (337) 513-7107

## Contact information

- **Practice address:** 5750 LAKE STREET, SUITE 100, LAKE CHARLES, LA 70605
- **Practice address phone:** (337) 513-7107
- **Mailing address:** 5750 LAKE STREET, SUITE 100, LAKE CHARLES, LA 70605

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | Yes |
| 225100000X | Physical Therapist | — | — | Yes |

## Other

- **Enumeration date:** 01/12/2023
- **Last updated:** 01/12/2023