Provider Demographics
NPI:1629683180
Name:MURRAY, NATHANIEL ARTHUR (PT, DPT, MS)
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:ARTHUR
Last Name:MURRAY
Suffix:
Gender:M
Credentials:PT, DPT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4021 21ST AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-3071
Mailing Address - Country:US
Mailing Address - Phone:920-419-2078
Mailing Address - Fax:
Practice Address - Street 1:5525 CEDAR LAKE RD S
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1420
Practice Address - Country:US
Practice Address - Phone:952-541-7171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11993225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist