Provider Demographics
NPI:1467551846
Name:LUSKY, BETH WALLACE (PT)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:WALLACE
Last Name:LUSKY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1216 RUNNYMEDE LN
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-2550
Mailing Address - Country:US
Mailing Address - Phone:410-838-8161
Mailing Address - Fax:410-836-9632
Practice Address - Street 1:THE WELLSPRING CENTER
Practice Address - Street 2:658 BOULTON ST.
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4214
Practice Address - Country:US
Practice Address - Phone:410-836-9622
Practice Address - Fax:410-836-9632
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15945225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD443M640Medicare ID - Type UnspecifiedPHYSICAL THERAPIST