Healthcare Provider Details

I. General information

NPI: 1356317994
Provider Name (Legal Business Name): JOSEPH FRANCIS CIMINO A.T.,C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15420 19 MILE RD SUITE 100
CLINTON TOWNSHIP MI
48038-6339
US

IV. Provider business mailing address

10983 LESURE DR
STERLING HEIGHTS MI
48312-1244
US

V. Phone/Fax

Practice location:
  • Phone: 586-228-4830
  • Fax: 586-228-4840
Mailing address:
  • Phone: 586-979-8204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: