Provider Demographics
NPI:1982170874
Name:MUSGRAVE, ADAM (PTA)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:MUSGRAVE
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 QUINCY AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-3042
Mailing Address - Country:US
Mailing Address - Phone:440-637-7508
Mailing Address - Fax:
Practice Address - Street 1:7921 PROFESSIONAL CIR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-1901
Practice Address - Country:US
Practice Address - Phone:714-847-8751
Practice Address - Fax:714-847-8913
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-17
Last Update Date:2018-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49584208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation