Provider Demographics
NPI:1447738463
Name:ADLER, EMILY ROSE (ATC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ROSE
Last Name:ADLER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4258 W FIGARDEN DR APT 212
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-8634
Mailing Address - Country:US
Mailing Address - Phone:479-301-5666
Mailing Address - Fax:
Practice Address - Street 1:4258 W FIGARDEN DR APT 212
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-8634
Practice Address - Country:US
Practice Address - Phone:479-301-5666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20000330662255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA185504290111Other22 (RESPIRATORY, REHABILITATIVE & RESTORATIVE SERVICE PROVIDERS