Provider Demographics
NPI:1871888693
Name:ST LOUIS MEDICAL REHAB GROUP LLC
Entity type:Organization
Organization Name:ST LOUIS MEDICAL REHAB GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-443-8667
Mailing Address - Street 1:8045 BIG BEND BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WEBSTER GROVES
Mailing Address - State:MO
Mailing Address - Zip Code:63119-2714
Mailing Address - Country:US
Mailing Address - Phone:314-443-8667
Mailing Address - Fax:
Practice Address - Street 1:8045 BIG BEND BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:WEBSTER GROVES
Practice Address - State:MO
Practice Address - Zip Code:63119-2714
Practice Address - Country:US
Practice Address - Phone:314-443-8667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-09
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301089175207RG0300X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty