Provider Demographics
NPI:1912020801
Name:TIERNEY, TOM JOSEPH (PT)
Entity Type:Individual
Prefix:
First Name:TOM
Middle Name:JOSEPH
Last Name:TIERNEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 YELLOW STAR CT
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-1702
Mailing Address - Country:US
Mailing Address - Phone:630-960-0783
Mailing Address - Fax:630-321-1711
Practice Address - Street 1:8236 S MADISON ST
Practice Address - Street 2:
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-5811
Practice Address - Country:US
Practice Address - Phone:630-321-1717
Practice Address - Fax:630-321-1711
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL70005016225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist