Provider Demographics
NPI:1114945151
Name:CRATER, CHRISTOPHER K (ATC)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:K
Last Name:CRATER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 677
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88062-0677
Mailing Address - Country:US
Mailing Address - Phone:505-313-0762
Mailing Address - Fax:505-538-6163
Practice Address - Street 1:1000 W. COLLEGE AVENUE
Practice Address - Street 2:WNMU ATHLETIC DEPARTMENT
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88062
Practice Address - Country:US
Practice Address - Phone:505-538-6236
Practice Address - Fax:505-538-6163
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3032255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer