Provider Demographics
NPI:1942573365
Name:PROBST, ALAN M (DPT)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:M
Last Name:PROBST
Suffix:
Gender:M
Credentials:DPT
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Mailing Address - Street 1:784 GRAVOIS BLUFFS BLVD
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-7726
Mailing Address - Country:US
Mailing Address - Phone:636-349-8060
Mailing Address - Fax:636-349-9171
Practice Address - Street 1:3950 VOGEL RD
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MO
Practice Address - Zip Code:63010-3790
Practice Address - Country:US
Practice Address - Phone:636-461-0900
Practice Address - Fax:636-461-0047
Is Sole Proprietor?:No
Enumeration Date:2012-02-15
Last Update Date:2015-07-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2012004499225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO991509012Medicare PIN