Basic Information
| Provider Information | |||||||||
| NPI: | 1003299132 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AARON | ||||||||
| FirstName: | MICHAEL | ||||||||
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| Credential: | ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1325 HAMPTON AVE | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631393113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6183027309 | ||||||||
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| Practice Location | |||||||||
| Address1: | 633 EMERSON RD STE 20 | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631416739 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3143253068 | ||||||||
| FaxNumber: | 3143253069 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2015 | ||||||||
| LastUpdateDate: | 07/07/2015 | ||||||||
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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 | 2255A2300X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.