Michael Shane Tierney
Specialist/Technologist, Athletic Trainer in Mc Lean, VA. Individual provider (NPI-1).
NPI number1073197679
StatusActive
Last updated in NPPESMay 10, 2021
Details
- NPI
- 1073197679
- Entity type
- Individual (NPI-1)
- Name
- Michael Shane Tierney
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- May 10, 2021
- Certification date
- May 10, 2021
- Last updated
- May 10, 2021
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 2255A2300X | Specialist/Technologist, Athletic Trainer | 0126001718 | VA | Yes |
Practice location
1633 Davidson RdMc Lean, VA 22101-4399
Phone 703-714-5771
Mailing address
1633 Davidson RdMc Lean, VA 22101-4399
Phone 703-714-5771
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