Individual
DR. SHINICHIRO SUGIURA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D., LAT, ATC
Contact information
Practice address
146 REC HALL, UNIVERSITY PARK, PA 16803-1680
(814) 865-8387
Mailing address
THE PENNSYLVANIA STATE UNIVERSITY, 146 REC HALL, UNIVERSITY PARK, PA 16803-1590
(814) 865-8387
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
36001406A
IN
2255A2300X
Athletic Trainer
Primary
RT007420
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
36001406A
ATHLETIC TRAINER
IN
01
—
RT007420
ATHLETIC TRAINER
PA
Enumeration date
02/17/2006
Last updated
08/31/2020
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