Individual
MR. RUSTY LEE MUSICK II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2121 BOLT RD, FAIRDALE, WV 25839-9610
(304) 573-3134
Mailing address
2121 BOLT RD, FAIRDALE, WV 25839-9610
(304) 573-3134
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
24-948
WV
Other
Enumeration date
10/24/2025
Last updated
10/24/2025
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