Healthcare Provider Details

I. General information

NPI: 1205643780
Provider Name (Legal Business Name): TRISTAN JAMES MONTERA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2024
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 SHILOH RD
TUSCULUM TN
37745-0595
US

IV. Provider business mailing address

926 APPLE ST APT 5
GREENEVILLE TN
37745-4073
US

V. Phone/Fax

Practice location:
  • Phone: 423-636-7300
  • Fax:
Mailing address:
  • Phone: 714-473-2846
  • 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: