Provider Demographics
NPI:1104531011
Name:TYRRELL, EMILY JOY (MS, ACSM-CEP)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:JOY
Last Name:TYRRELL
Suffix:
Gender:F
Credentials:MS, ACSM-CEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4430 21ST ST SE APT 126
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-6476
Mailing Address - Country:US
Mailing Address - Phone:701-260-7988
Mailing Address - Fax:
Practice Address - Street 1:7500 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-9652
Practice Address - Country:US
Practice Address - Phone:701-355-5160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist