Provider Demographics
NPI:1265300032
Name:MUSICK, RUSTY LEE II
Entity type:Individual
Prefix:MR
First Name:RUSTY
Middle Name:LEE
Last Name:MUSICK
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 BOLT RD
Mailing Address - Street 2:
Mailing Address - City:FAIRDALE
Mailing Address - State:WV
Mailing Address - Zip Code:25839-9610
Mailing Address - Country:US
Mailing Address - Phone:304-573-3134
Mailing Address - Fax:
Practice Address - Street 1:2121 BOLT RD
Practice Address - Street 2:
Practice Address - City:FAIRDALE
Practice Address - State:WV
Practice Address - Zip Code:25839-9610
Practice Address - Country:US
Practice Address - Phone:304-573-3134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-24
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV24-948175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist