Provider Demographics
NPI:1770579393
Name:LUSK, SARAH DEWIT (PT, OCS)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:DEWIT
Last Name:LUSK
Suffix:
Gender:F
Credentials:PT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 MCMEANS AVE
Mailing Address - Street 2:
Mailing Address - City:BAY MINETTE
Mailing Address - State:AL
Mailing Address - Zip Code:36507-3333
Mailing Address - Country:US
Mailing Address - Phone:251-937-4700
Mailing Address - Fax:251-937-4708
Practice Address - Street 1:2115 HAND AVE
Practice Address - Street 2:
Practice Address - City:BAY MINETTE
Practice Address - State:AL
Practice Address - Zip Code:36507-4149
Practice Address - Country:US
Practice Address - Phone:251-937-2823
Practice Address - Fax:251-937-2821
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH4012225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051515571LUSMedicare ID - Type Unspecified
ALP89879Medicare UPIN