NPIMap

Organization Active NPI

Innovative Therapy Services, LLC

Doing business as Mobile Physical Therapy

  • Physical Therapist
  • Saint Louis, MO
National Provider Identifier
1912100165
Registry record updated Mar 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2005012155 Issued in MO
Legal business name
INNOVATIVE THERAPY SERVICES, LLC
Doing business as
Mobile Physical Therapy
Practice address
1310 Papin St
Suite 109
Saint Louis, MO 63103-3132
Phone
(315) 558-1385
Fax
(314) 335-7770
NPI assigned
Jun 6, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2015

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

Authorized official

Name
Bradley Bruce Abrams, PTNPI 1366458325
Title
President
Phone
(314) 255-9749

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X 2005012155 MO Primary

Addresses

Primary practice location

1310 Papin St
Suite 109
Saint Louis, MO 63103-3132

Mailing address

1310 Papin St
Suite 109
Saint Louis, MO 63103-3132
Phone (315) 558-1385

Other identifiers 1

IdentifierTypeStateIssuer
504583105MedicaidMO

Other names 1

  • Mobile Physical Therapy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051221000516 MO Part B Supplier - Clinic/Group Practice 6709808546 Receives reassigned benefits from 8 practitioners
Practice locations: Saint Louis, MO

National Provider Directory

National Provider Directory

Locations

1218 S Jefferson Ave
#J
Saint Louis, MO 63104
Phone (314) 558-1385

1310 Papin St
Ste 109
Saint Louis, MO 63103
Phone (314) 558-1385

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1181088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426809600000",
    "number": "1912100165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1310 PAPIN ST",
            "address_2": "SUITE 109",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631033132",
            "telephone_number": "315-558-1385",
            "fax_number": "314-335-7770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 PAPIN ST",
            "address_2": "SUITE 109",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631033132",
            "telephone_number": "315-558-1385",
            "fax_number": "314-335-7770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INNOVATIVE THERAPY SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-06",
        "last_updated": "2015-03-20",
        "status": "A",
        "authorized_official_last_name": "ABRAMS",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_middle_name": "BRUCE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "314-255-9749",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "MO",
            "license": "2005012155",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "504583105",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mobile Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Mar 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.