Provider Demographics
NPI:1518425024
Name:SITLER, KRISTA RAE (ATC)
Entity Type:Individual
Prefix:MS
First Name:KRISTA
Middle Name:RAE
Last Name:SITLER
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 1:7632 SOUTHSIDE BLVD APT 383
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-7083
Mailing Address - Country:US
Mailing Address - Phone:330-814-0595
Mailing Address - Fax:
Practice Address - Street 1:3351 HENDRICKS AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-5301
Practice Address - Country:US
Practice Address - Phone:904-402-4399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL54152255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAL5415OtherATHLETIC TRAINER