Individual
KEITH MUSHINSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
J1-0002255
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11797340
CAQH
—
01
—
1265634471
CHAMPUS TRICARE
—
05
—
1265634471
—
DE
01
—
2872480000
IBC AMERIHEALTH
—
Enumeration date
06/01/2007
Last updated
03/22/2013
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