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General NPI Number Information
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NPI Number | 1346217460
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Entity Type | Individual
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Provider Name | JOEL D. CRYDER ATC, CSCS
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Gender | Male
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Dates
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Enumeration Date | 03/07/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6800 WYDOWN BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63105-3043
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Country | US
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Telephone | 314-889-1456
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Fax | 314-889-4507
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Provider Business Mailing Address
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Address Line | 206 KANSAS AVE
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City | BELLEVILLE
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State | IL
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Zip | 62221-4940
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Country | US
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Telephone | 619-310-1481
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2004035413
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License Number State | MO
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