Individual
TIARRA TANAE JOSEPH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, LAT, ATC
Contact information
Practice address
122 E 6TH AVE, ROSELLE, NJ 07203-2081
(908) 298-2000
Mailing address
2280 PERSHING RD, UNION, NJ 07083-5126
(862) 755-5850
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
25MT00260300
NJ
Other
Enumeration date
10/16/2019
Last updated
10/16/2019
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