=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477490860
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE TRAINING ROOM LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2026
-----------------------------------------------------
Last Update Date | 05/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 59 S BROWN ST
-----------------------------------------------------
City | RHINELANDER
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54501-3450
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-513-6121
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 59 S BROWN ST
-----------------------------------------------------
City | RHINELANDER
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54501-3450
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-513-6121
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, ATHLETIC TRAINER
-----------------------------------------------------
Name | ETHAN WILLEY
-----------------------------------------------------
Credential | ATC
-----------------------------------------------------
Telephone | 715-513-6121
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------