Provider Demographics
NPI:1376675652
Name:TIERMINI, JEREMY (MSS, ATC)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:
Last Name:TIERMINI
Suffix:
Gender:M
Credentials:MSS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 SENECA DR
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-1145
Mailing Address - Country:US
Mailing Address - Phone:585-396-7259
Mailing Address - Fax:
Practice Address - Street 1:4355 LAKESHORE DR
Practice Address - Street 2:FINGER LAKES COMMUNITY COLLEGE
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-8347
Practice Address - Country:US
Practice Address - Phone:585-394-3500
Practice Address - Fax:585-394-5005
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001118-12255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer