Provider Demographics
NPI:1295801892
Name:TRAINING ROOM PROFESSIONAL ATHLETIC SERVICES, LLC
Entity type:Organization
Organization Name:TRAINING ROOM PROFESSIONAL ATHLETIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-619-1733
Mailing Address - Street 1:1819 E BIG BEAVER RD
Mailing Address - Street 2:STE 200
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-2015
Mailing Address - Country:US
Mailing Address - Phone:248-619-1733
Mailing Address - Fax:248-619-1744
Practice Address - Street 1:1819 E BIG BEAVER RD
Practice Address - Street 2:STE 200
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-2015
Practice Address - Country:US
Practice Address - Phone:248-619-1733
Practice Address - Fax:248-619-1744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
30696OtherBCBS FACILITY ID
30696OtherBCBS FACILITY ID