MEDICARE: ADVANCED PHYSICAL THERAPY & FITNESS 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	225100000X	Physical Therapist	01720	MO

General Provider Information

NPI Number	:	1164414918
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED PHYSICAL THERAPY & FITNESS LLC

Provider Business Mailing Address
First Line	:	960 PLAZA DR STE G
Second Line	:
City	:	SAINT CLAIR
State	:	MO
Zip	:	63077-1146
Country	:	US
Telephone Number	:	636-629-7778
Fax Number	:	636-629-7778

Provider Business Practice Location Address
First Line	:	960 PLAZA DR STE G
Second Line	:
City	:	SAINT CLAIR
State	:	MO
Zip	:	63077-1146
Country	:	US
Telephone Number	:	636-629-7778
Fax Number	:	636-629-7778

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. LAURIE A AUBUCHON
Credential	:	R.P.T.
Telephone Number	:	636-629-7778

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	04/10/2014

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