Healthcare Provider Details

I. General information

NPI: 1326016932
Provider Name (Legal Business Name): ROCCO CAMILLO TIERI ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 S ELMHURST RD
WHEELING IL
60090-5507
US

IV. Provider business mailing address

900 S ELMHURST RD
WHEELING IL
60090-5507
US

V. Phone/Fax

Practice location:
  • Phone: 847-718-7136
  • Fax:
Mailing address:
  • Phone: 847-718-7136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: