Provider Demographics
NPI:1235255258
Name:MUSGROVE, DAVID G (PT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:G
Last Name:MUSGROVE
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 1:4572 TELEPHONE RD STE 903
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-5663
Mailing Address - Country:US
Mailing Address - Phone:805-654-8127
Mailing Address - Fax:
Practice Address - Street 1:1701 SOLAR DR
Practice Address - Street 2:STE 155
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-0139
Practice Address - Country:US
Practice Address - Phone:805-654-8127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17172225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT17172AMedicare ID - Type UnspecifiedPT