Provider Demographics
NPI:1770827321
Name:MUSGROVE, PAULA J (RPT)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:J
Last Name:MUSGROVE
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4690 ASHLEY CT
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-3160
Mailing Address - Country:US
Mailing Address - Phone:314-740-5960
Mailing Address - Fax:
Practice Address - Street 1:1551 WALL ST
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-3539
Practice Address - Country:US
Practice Address - Phone:636-947-1666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO01765225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist