Individual
MICHAEL SHANE TIERNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1633 DAVIDSON RD, MC LEAN, VA 22101-4399
(703) 714-5771
Mailing address
1633 DAVIDSON RD, MC LEAN, VA 22101-4399
(703) 714-5771
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
0126001718
VA
Other
Enumeration date
05/10/2021
Last updated
05/10/2021
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