Provider Demographics
NPI:1790669588
Name:TRANSPORT THERAPY LLC
Entity type:Organization
Organization Name:TRANSPORT THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TOMICICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-346-7826
Mailing Address - Street 1:106 COUNTRY TRACE CT
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63304-2815
Mailing Address - Country:US
Mailing Address - Phone:636-346-7826
Mailing Address - Fax:636-332-0776
Practice Address - Street 1:340 MEADOW GROVE CT
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63304-6782
Practice Address - Country:US
Practice Address - Phone:636-346-7826
Practice Address - Fax:636-332-0776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-04
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty