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NPI Code Detail

MEDICARE: MIGUEL MUSNGI

MEDICARE: MIGUEL MUSNGI
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
1225200000XPhysical Therapy Assistant160.006741IL

General Provider Information

NPI Number : 1750792396
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIGUEL MUSNGI
Provider Business Mailing Address
First Line : 163 HOLLY ST
Second Line :
City : BOLINGBROOK
State : IL
Zip : 60490-2106
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 12550 S RIDGELAND AVE
Second Line :
City : PALOS HEIGHTS
State : IL
Zip : 60463-1859
Country : US
Telephone Number : 708-597-9300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2014
Last Update Date : 05/16/2014

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