Healthcare Provider Details

I. General information

NPI: 1225547037
Provider Name (Legal Business Name): LISA K MURTON ATC,LAT,CSCS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2017
Last Update Date: 09/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

771 N FREEDOM ST
RAVENNA OH
44266-2470
US

IV. Provider business mailing address

9781 WINDHAM PARKMAN RD
WINDHAM OH
44288-9709
US

V. Phone/Fax

Practice location:
  • Phone: 330-297-9020
  • Fax:
Mailing address:
  • Phone: 330-357-9634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1510
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: