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General NPI Number Information
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NPI Number | 1154005197
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Entity Type | Individual
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Provider Name | JESSE LOUIS TIERNO
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Gender | Male
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Dates
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Enumeration Date | 06/12/2023
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Last Update Date | 08/16/2023
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Provider Practice Location Address
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Address Line | 999 ROUTE 73 N
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City | MARLTON
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State | NJ
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Zip | 08053-1227
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Country | US
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Telephone | 856-821-6339
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Fax |
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Provider Business Mailing Address
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Address Line | 3 SNOWBERRY CT
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City | SICKLERVILLE
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State | NJ
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Zip | 08081-4108
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Country | US
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Telephone | 856-723-3734
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA02191200
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License Number State |
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