MEDICARE: RACE STL LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist	2007006528	MO

General Provider Information

NPI Number	:	1023361169
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RACE STL LLC

Provider Business Mailing Address
First Line	:	3155 SUTTON BLVD
Second Line	:	SUITE 203
City	:	SAINT LOUIS
State	:	MO
Zip	:	63143-3917
Country	:	US
Telephone Number	:	314-398-7198
Fax Number	:	314-646-8881

Provider Business Practice Location Address
First Line	:	3155 SUTTON BLVD
Second Line	:	SUITE 203
City	:	SAINT LOUIS
State	:	MO
Zip	:	63143-3917
Country	:	US
Telephone Number	:	314-398-7198
Fax Number	:	314-646-8881

Authorized Official
Title or Position	:	OWNER- PHYSICAL THERAPIST
Name	:	ARIE POREMBA
Credential	:	PT, DPT
Telephone Number	:	314-398-7198

Provider Enumeration Date	:	10/25/2012
Last Update Date	:	11/21/2013

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Directions to “RACE STL LLC ” Practice Location

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