Provider Demographics
NPI:1043588155
Name:MURATA, DAVID (LMT, BS, NCTMB, MDIV)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:MURATA
Suffix:
Gender:M
Credentials:LMT, BS, NCTMB, MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 E. MANOA RD.
Mailing Address - Street 2:MAINLINE MEDICAL MASSAGE
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083
Mailing Address - Country:US
Mailing Address - Phone:610-357-7283
Mailing Address - Fax:
Practice Address - Street 1:1207 COUNTY LINE RD
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-2614
Practice Address - Country:US
Practice Address - Phone:610-357-7283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-03
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG003978225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist