Healthcare Provider Details

I. General information

NPI: 1003299132
Provider Name (Legal Business Name): MICHAEL AARON ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2015
Last Update Date: 07/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 EMERSON RD STE 20
SAINT LOUIS MO
63141-6739
US

IV. Provider business mailing address

1325 HAMPTON AVE
SAINT LOUIS MO
63139-3113
US

V. Phone/Fax

Practice location:
  • Phone: 314-325-3068
  • Fax: 314-325-3069
Mailing address:
  • Phone: 618-302-7309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: