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General NPI Number Information
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NPI Number | 1558652644
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Entity Type | Organization
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Legal Business Name | PRO-MOTION PT LLC
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Dates
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Enumeration Date | 04/25/2011
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Last Update Date | 04/25/2011
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Provider Practice Location Address
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Address Line | 4642 SHENANDOAH AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63110-3424
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Country | US
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Telephone | 314-686-3008
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Fax |
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Provider Business Mailing Address
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Address Line | 3943 JUNIATA ST
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City | SAINT LOUIS
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State | MO
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Zip | 63116-3911
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Country | US
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Telephone | 314-686-3008
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | MR. AZHAR SHAH
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Credential | MSPT
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Telephone | 314-686-3008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2007028770
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License Number State | MO
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