Healthcare Provider Details

I. General information

NPI: 1477490860
Provider Name (Legal Business Name): THE TRAINING ROOM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2026
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 S BROWN ST
RHINELANDER WI
54501-3450
US

IV. Provider business mailing address

59 S BROWN ST
RHINELANDER WI
54501-3450
US

V. Phone/Fax

Practice location:
  • Phone: 715-513-6121
  • Fax:
Mailing address:
  • Phone: 715-513-6121
  • 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: ETHAN WILLEY
Title or Position: OWNER, ATHLETIC TRAINER
Credential: ATC
Phone: 715-513-6121