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NPI Code Detail

MEDICARE: THERESA LYNN MUSGRAVE PA-C

MEDICARE: THERESA LYNN MUSGRAVE PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant50.003101OH

General Provider Information

NPI Number : 1356651558
Entity Type Code : Individual
Provider Name (Legal Business Name) : THERESA LYNN MUSGRAVE PA-C
Provider Business Mailing Address
First Line : 333 N SUMMIT ST FL 7
Second Line :
City : TOLEDO
State : OH
Zip : 43604-1531
Country : US
Telephone Number : 419-578-7200
Fax Number : 419-537-5600
Provider Business Practice Location Address
First Line : 2865 N REYNOLDS RD BLDG A
Second Line :
City : TOLEDO
State : OH
Zip : 43615-2100
Country : US
Telephone Number : 419-578-7200
Fax Number : 419-537-5600
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/21/2010
Last Update Date : 11/03/2023

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