Provider Demographics
NPI:1346217460
Name:CRYDER, JOEL D (ATC, CSCS)
Entity Type:Individual
Prefix:MR
First Name:JOEL
Middle Name:D
Last Name:CRYDER
Suffix:
Gender:M
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 KANSAS AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62221-4940
Mailing Address - Country:US
Mailing Address - Phone:619-310-1481
Mailing Address - Fax:
Practice Address - Street 1:6800 WYDOWN BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63105-3043
Practice Address - Country:US
Practice Address - Phone:314-889-1456
Practice Address - Fax:314-889-4507
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20040354132255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer