NPIMap

Organization Active NPI

Professional Athletic Rehabilitation, LLC

  • Athletic Trainer
  • Saint Louis, MO
National Provider Identifier
1184900516
Registry record updated Oct 31, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Athletic TrainerTaxonomy code 2255A2300X
Legal business name
PROFESSIONAL ATHLETIC REHABILITATION, LLC
Practice address
1 University Blvd
225 Mark Twain Building
Saint Louis, MO 63121-4400
Phone
(314) 598-1663
Fax
(314) 516-5503
NPI assigned
Oct 31, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Michael Patrick Berry, LAT
Title
Director of Sports Medicine
Phone
(314) 598-1663

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Athletic TrainerGroup: 193400000X SINGLE SPECIALTY GROUP 2255A2300X Primary

Addresses

Primary practice location

1 University Blvd
225 Mark Twain Building
Saint Louis, MO 63121-4400

Mailing address

1 University Blvd
225 Mark Twain Building
Saint Louis, MO 63121-4400
Phone (314) 598-1663

National Provider Directory

National Provider Directory

Locations

1 University Blvd
#225
Saint Louis, MO 63121
Phone (314) 598-1663

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1320019200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320019200000",
    "number": "1184900516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 UNIVERSITY BLVD",
            "address_2": "225 MARK TWAIN BUILDING",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631214400",
            "telephone_number": "314-598-1663",
            "fax_number": "314-516-5503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 UNIVERSITY BLVD",
            "address_2": "225 MARK TWAIN BUILDING",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631214400",
            "telephone_number": "314-598-1663",
            "fax_number": "314-516-5503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL ATHLETIC REHABILITATION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-31",
        "last_updated": "2011-10-31",
        "status": "A",
        "authorized_official_last_name": "BERRY",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "PATRICK",
        "authorized_official_title_or_position": "DIRECTOR OF SPORTS MEDICINE",
        "authorized_official_telephone_number": "314-598-1663",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LAT"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.