Basic Information
| Provider Information | |||||||||
| NPI: | 1942573365 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PROBST | ||||||||
| FirstName: | ALAN | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 784 GRAVOIS BLUFFS BLVD | ||||||||
| Address2: | |||||||||
| City: | FENTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630267726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6363498060 | ||||||||
| FaxNumber: | 6363499171 | ||||||||
| Practice Location | |||||||||
| Address1: | 3950 VOGEL RD | ||||||||
| Address2: | |||||||||
| City: | ARNOLD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630103790 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6364610900 | ||||||||
| FaxNumber: | 6364610047 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2012 | ||||||||
| LastUpdateDate: | 07/13/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2012004499 | MO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.