Provider Demographics
NPI:1013514413
Name:LUSK, BRANDON (PT, DPT)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:LUSK
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 26TH ST S
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22206-2877
Mailing Address - Country:US
Mailing Address - Phone:703-586-5429
Mailing Address - Fax:
Practice Address - Street 1:1420 SPRING HILL RD STE 202
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-3026
Practice Address - Country:US
Practice Address - Phone:571-765-1730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist