Provider Demographics
NPI:1780238824
Name:MUSIAL, JAY NICHOLAS (PT)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:NICHOLAS
Last Name:MUSIAL
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 1:477 23 RD
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81507-1387
Mailing Address - Country:US
Mailing Address - Phone:330-261-6037
Mailing Address - Fax:
Practice Address - Street 1:2373 G RD STE 200
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-1006
Practice Address - Country:US
Practice Address - Phone:970-243-3061
Practice Address - Fax:970-245-8369
Is Sole Proprietor?:No
Enumeration Date:2019-07-26
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0015153225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist