Healthcare Provider Details

I. General information

NPI: 1174576045
Provider Name (Legal Business Name): ADVANCED TRAINING AND REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 10/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14450 S OUTER 40
CHESTERFIELD MO
63017-5711
US

IV. Provider business mailing address

14450 S OUTER 40
CHESTERFIELD MO
63017-5711
US

V. Phone/Fax

Practice location:
  • Phone: 314-434-6060
  • Fax: 314-434-6066
Mailing address:
  • Phone: 314-434-6060
  • Fax: 314-434-6066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: JIM S HOFMAN
Title or Position: MANAGING MEMBER
Credential:
Phone: 314-453-9997