Provider Demographics
NPI:1972708253
Name:MUSENBROCK, DANIEL (MS,PT,CSCS)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:
Last Name:MUSENBROCK
Suffix:
Gender:M
Credentials:MS,PT,CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2346 MASCOUTAH AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62220-3499
Mailing Address - Country:US
Mailing Address - Phone:618-277-6282
Mailing Address - Fax:618-277-6284
Practice Address - Street 1:2346 MASCOUTAH AVE
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62220-3499
Practice Address - Country:US
Practice Address - Phone:618-277-6282
Practice Address - Fax:618-277-6284
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist