Provider Demographics
NPI:1003461435
Name:MUSGNUG, GREGORY C (DPT)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:C
Last Name:MUSGNUG
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 BRIDGE BARRIER RD STE 3
Mailing Address - Street 2:
Mailing Address - City:CAROLINA BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28428-3939
Mailing Address - Country:US
Mailing Address - Phone:910-636-3574
Mailing Address - Fax:
Practice Address - Street 1:1300 BRIDGE BARRIER RD STE 3
Practice Address - Street 2:
Practice Address - City:CAROLINA BEACH
Practice Address - State:NC
Practice Address - Zip Code:28428-3939
Practice Address - Country:US
Practice Address - Phone:910-636-3574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-02
Last Update Date:2020-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP19057225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist