Provider Demographics
NPI:1255890679
Name:DIIORIO, MICHELLE RENEE (AT-C)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:RENEE
Last Name:DIIORIO
Suffix:
Gender:F
Credentials:AT-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 W US HIGHWAY 50
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-1618
Mailing Address - Country:US
Mailing Address - Phone:719-253-7102
Mailing Address - Fax:719-253-7114
Practice Address - Street 1:1919 W US HIGHWAY 50
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-1618
Practice Address - Country:US
Practice Address - Phone:719-253-7102
Practice Address - Fax:719-253-7114
Is Sole Proprietor?:No
Enumeration Date:2019-03-15
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO120402109247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO120402109OtherNATIONAL ATHLETIC TRAINERS' ASSOCIATION