Healthcare Provider Details

I. General information

NPI: 1811347149
Provider Name (Legal Business Name): MURPHY MARK LUATUA MS, LAT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2016
Last Update Date: 06/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

844 WASHINGTON RD SUITE 101
WESTMINSTER MD
21157-6664
US

IV. Provider business mailing address

9107 THISTLEDOWN RD APT. 167
OWINGS MILLS MD
21117-8255
US

V. Phone/Fax

Practice location:
  • Phone: 410-876-5600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberA0000468
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: