Provider Demographics
NPI:1285306548
Name:MURRAY, CULLEN (LAT, ATC)
Entity type:Individual
Prefix:
First Name:CULLEN
Middle Name:
Last Name:MURRAY
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12112 35TH AVE
Mailing Address - Street 2:
Mailing Address - City:PLEASANT PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53158-4266
Mailing Address - Country:US
Mailing Address - Phone:262-705-4580
Mailing Address - Fax:
Practice Address - Street 1:2001 ALFORD DR
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53140-1927
Practice Address - Country:US
Practice Address - Phone:262-551-6000
Practice Address - Fax:262-551-5809
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer