Healthcare Provider Details

I. General information

NPI: 1154556264
Provider Name (Legal Business Name): PAUL HIROTSUNE MURATA M.ED., ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2009
Last Update Date: 07/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 PHARMACY AVENUE SUITE 401
TORONTO ONTARIO
M1R 2H2
CA

IV. Provider business mailing address

1101 PHARMACY AVENUE SUITE 401
TORONTO ONTARIO
M1R 2H2
CA

V. Phone/Fax

Practice location:
  • Phone: 647-802-8902
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT003168
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number0126001359
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: