Provider Demographics
NPI:1174576045
Name:ADVANCED TRAINING AND REHAB LLC
Entity type:Organization
Organization Name:ADVANCED TRAINING AND REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:S
Authorized Official - Last Name:HOFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-453-9997
Mailing Address - Street 1:14450 S OUTER 40
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-5711
Mailing Address - Country:US
Mailing Address - Phone:314-434-6060
Mailing Address - Fax:314-434-6066
Practice Address - Street 1:14450 S OUTER 40
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-5711
Practice Address - Country:US
Practice Address - Phone:314-434-6060
Practice Address - Fax:314-434-6066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty