MEDICARE: MRS. JOAN M GIERA ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	096-001692	IL

General Provider Information

NPI Number	:	1619945284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JOAN M GIERA ATC

Provider Business Mailing Address
First Line	:	7630 160TH ST
Second Line	:
City	:	TINLEY PARK
State	:	IL
Zip	:	60477-1321
Country	:	US
Telephone Number	:	630-661-7903
Fax Number	:

Provider Business Practice Location Address
First Line	:	9000 WAUKEGAN RD
Second Line	:
City	:	MORTON GROVE
State	:	IL
Zip	:	60053-2127
Country	:	US
Telephone Number	:	847-779-6091
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	05/20/2009

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