Provider Demographics
NPI:1174826424
Name:MUSICK, JODY ERIC (PT)
Entity Type:Individual
Prefix:MR
First Name:JODY
Middle Name:ERIC
Last Name:MUSICK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 ROY MARTIN RD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-2244
Mailing Address - Country:US
Mailing Address - Phone:423-477-1101
Mailing Address - Fax:423-477-1102
Practice Address - Street 1:110 E CENTER ST
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-4230
Practice Address - Country:US
Practice Address - Phone:423-765-1611
Practice Address - Fax:423-765-1612
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-08
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6591225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4293094OtherBLUE CROSS BLUE SHIELD TN
TN4293094Medicaid
TNQ004105Medicaid