1154556264 NPI number — MR. PAUL HIROTSUNE MURATA M.ED., ATC

Table of content: MR. PAUL HIROTSUNE MURATA M.ED., ATC (NPI 1154556264)

General
Organization/Personal Information
Provider's Other Name Information
NPI Number Information
Provider's Business Mailing Address
Provider's Practice Location Mailing Address
Additional Information
Authorized Official
Provider Taxonomy Codes
Other Provider's Identifiers (legacy, non-NPI)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154556264 NPI number — MR. PAUL HIROTSUNE MURATA M.ED., ATC

Organization/Personal Information

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:
MURATA

Provider First Name:
PAUL

Provider Middle Name:
HIROTSUNE

Provider Name Prefix Text:
MR.

Provider Name Suffix Text:

Provider Credential Text:
M.ED., ATC

Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154556264

Entity Type Code:
Individual

Replacement NPI:

Last Update Date:
07/10/2019

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1101 PHARMACY AVENUE

Provider Second Line Business Mailing Address:
SUITE 401

Provider Business Mailing Address City Name:
TORONTO

Provider Business Mailing Address State Name:
ONTARIO

Provider Business Mailing Address Postal Code:
M1R 2H2

Provider Business Mailing Address Country Code:
CA

Provider Business Mailing Address Telephone Number:

Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1101 PHARMACY AVENUE

Provider Second Line Business Practice Location Address:
SUITE 401

Provider Business Practice Location Address City Name:
TORONTO

Provider Business Practice Location Address State Name:
ONTARIO

Provider Business Practice Location Address Postal Code:
M1R 2H2

Provider Business Practice Location Address Country Code:
CA

Provider Business Practice Location Address Telephone Number:
647-802-8902

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:
05/18/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

Provider Taxonomy Codes

Taxonomy code: 2255A2300X , with the licence number: RT003168 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Taxonomy code: 2255A2300X , with the licence number: 0126001359 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .