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General NPI Number Information
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NPI Number | 1881824142
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Entity Type | Individual
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Provider Name | SHARON MARIE TIERNEY PTA
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Gender | Female
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Dates
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Enumeration Date | 07/21/2009
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Last Update Date | 02/05/2019
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Provider Practice Location Address
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Address Line | 750 ESSINGTON RD
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City | JOLIET
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State | IL
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Zip | 60435-4912
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Country | US
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Telephone | 815-729-2160
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Fax | 815-373-0099
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Provider Business Mailing Address
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Address Line | 9036 W EAGLE LAKE RD
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City | PEOTONE
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State | IL
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Zip | 60468-9613
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Country | US
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Telephone | 708-258-3649
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 160001786
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License Number State | IL
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