Provider Demographics
NPI:1861028029
Name:MUSICK, DARRELL R (PT)
Entity Type:Individual
Prefix:
First Name:DARRELL
Middle Name:R
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 1:1033 WILLOW LAKE RD
Mailing Address - Street 2:
Mailing Address - City:DISCOVERY BAY
Mailing Address - State:CA
Mailing Address - Zip Code:94505-9402
Mailing Address - Country:US
Mailing Address - Phone:650-224-4268
Mailing Address - Fax:
Practice Address - Street 1:1033 WILLOW LAKE RD
Practice Address - Street 2:
Practice Address - City:DISCOVERY BAY
Practice Address - State:CA
Practice Address - Zip Code:94505-9402
Practice Address - Country:US
Practice Address - Phone:650-224-4268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA160892251N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology