Provider Demographics
NPI:1467427104
Name:SUGIURA, SHINICHIRO (PHD, LAT, ATC)
Entity Type:Individual
Prefix:DR
First Name:SHINICHIRO
Middle Name:
Last Name:SUGIURA
Suffix:
Gender:M
Credentials:PHD, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:THE PENNSYLVANIA STATE UNIVERSITY
Mailing Address - Street 2:146 REC HALL
Mailing Address - City:UNIVERSITY PARK
Mailing Address - State:PA
Mailing Address - Zip Code:16803-1590
Mailing Address - Country:US
Mailing Address - Phone:814-865-8387
Mailing Address - Fax:
Practice Address - Street 1:146 REC HALL
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PARK
Practice Address - State:PA
Practice Address - Zip Code:16803-1680
Practice Address - Country:US
Practice Address - Phone:814-865-8387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36001406A2255A2300X
PART0074202255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
PART007420OtherATHLETIC TRAINER
IN36001406AOtherATHLETIC TRAINER