Healthcare Provider Details

I. General information

NPI: 1982024345
Provider Name (Legal Business Name): CRAIG ZURLIENE MHA, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2014
Last Update Date: 04/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 COLLEGE PARK DR
SAINT LOUIS MO
63141-8660
US

IV. Provider business mailing address

1 COLLEGE PARK DR
SAINT LOUIS MO
63141-8660
US

V. Phone/Fax

Practice location:
  • Phone: 314-392-2399
  • Fax:
Mailing address:
  • Phone: 314-392-2399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2014000963
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number096003682
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: