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General NPI Number Information
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NPI Number | 1790669588
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Entity Type | Organization
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Legal Business Name | TRANSPORT THERAPY LLC
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Dates
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Enumeration Date | 08/04/2025
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Last Update Date | 08/29/2025
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Provider Practice Location Address
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Address Line | 340 MEADOW GROVE CT
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City | SAINT PETERS
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State | MO
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Zip | 63304-6782
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Country | US
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Telephone | 636-346-7826
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Fax | 636-332-0776
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Provider Business Mailing Address
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Address Line | 106 COUNTRY TRACE CT
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City | SAINT PETERS
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State | MO
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Zip | 63304-2815
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Country | US
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Telephone | 636-346-7826
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Fax | 636-332-0776
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Authorized Official
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Title or Position | OWNER/ PROVIDER
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Name | JUSTIN TOMICICH
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Credential |
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Telephone | 636-346-7826
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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