Provider Demographics
NPI:1295902005
Name:MURAMATSU, MASAE (LMT)
Entity type:Individual
Prefix:MS
First Name:MASAE
Middle Name:
Last Name:MURAMATSU
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:MASAE
Other - Middle Name:MURAMATSU
Other - Last Name:PANCAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:15389 W HIGHWAY 318
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:FL
Mailing Address - Zip Code:32696-4312
Mailing Address - Country:US
Mailing Address - Phone:516-301-7743
Mailing Address - Fax:
Practice Address - Street 1:1002 NW 23RD AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609-5403
Practice Address - Country:US
Practice Address - Phone:516-301-7743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY27021753174400000X
FLMA54044174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist