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Individual

ROBERT MICHAEL SUPER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LAT, COF

Contact information

Practice address
1255 W 15TH ST STE 540, PLANO, TX 75075-7248
(410) 845-3929
(972) 767-3728
Mailing address
5571 EASTON RD., PIPERSVILLE, PA 18947
(410) 845-3929

Taxonomy

Speciality
Code
Description
License number
State
225000000X
Orthotic Fitter
OF000004
PA
2255A2300X
Athletic Trainer
Primary
RT005787
PA

Other

Enumeration date
05/12/2009
Last updated
04/27/2014
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