MEDICARE: MS. JOANN MURRAY A.T.,C, LAT, LAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	ATR001440	AZ
2	171100000X	Acupuncturist	ATR001440	AZ

General Provider Information

NPI Number	:	1811961733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JOANN MURRAY A.T.,C, LAT, LAC

Provider Business Mailing Address
First Line	:	4530 E RAY RD STE 110
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85044-6095
Country	:	US
Telephone Number	:	203-512-0572
Fax Number	:	832-202-0250

Provider Business Practice Location Address
First Line	:	4530 E RAY RD STE 110
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85044-6095
Country	:	US
Telephone Number	:	203-740-7500
Fax Number	:	203-740-1300

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	11/09/2018

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