Provider Demographics
NPI:1023361169
Name:RACE STL LLC
Entity Type:Organization
Organization Name:RACE STL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER- PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:POREMBA
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:314-398-7198
Mailing Address - Street 1:3155 SUTTON BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63143-3917
Mailing Address - Country:US
Mailing Address - Phone:314-398-7198
Mailing Address - Fax:314-646-8881
Practice Address - Street 1:3155 SUTTON BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63143-3917
Practice Address - Country:US
Practice Address - Phone:314-398-7198
Practice Address - Fax:314-646-8881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-25
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20070065282251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty