Provider Demographics
NPI:1063832848
Name:LUSK, DEREK J (DPT)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:J
Last Name:LUSK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 E 2ND AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1428
Mailing Address - Country:US
Mailing Address - Phone:509-455-6002
Mailing Address - Fax:509-747-5990
Practice Address - Street 1:407 E 2ND AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1428
Practice Address - Country:US
Practice Address - Phone:509-455-6002
Practice Address - Fax:509-747-5990
Is Sole Proprietor?:No
Enumeration Date:2014-04-21
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60385505225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0326459OtherWA STATE DEPT OF LABOR & INDUSTRIES
WA0326459OtherWA STATE DEPT OF LABOR & INDUSTRIES
WAG8930671Medicare PIN