Individual
MARISSA CREDLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1675 E MELROSE ST UNIT 101, GILBERT, AZ 85297-1001
(480) 964-2908
Mailing address
1675 E MELROSE ST UNIT 101, GILBERT, AZ 85297-1001
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
LPT-32457
AZ
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/28/2018
Last updated
07/13/2022
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