Provider Demographics
NPI:1255519930
Name:POREMBA, ARIE V (PT)
Entity type:Individual
Prefix:MR
First Name:ARIE
Middle Name:V
Last Name:POREMBA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:ARIK
Other - Middle Name:
Other - Last Name:POREMBA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:777 S NEW BALLAS RD
Mailing Address - Street 2:SUITE 218E
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8705
Mailing Address - Country:US
Mailing Address - Phone:314-991-2562
Mailing Address - Fax:314-991-2593
Practice Address - Street 1:777 S NEW BALLAS RD
Practice Address - Street 2:SUITE 218E
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8705
Practice Address - Country:US
Practice Address - Phone:314-991-2562
Practice Address - Fax:314-991-2593
Is Sole Proprietor?:No
Enumeration Date:2008-02-05
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007006528225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist