Provider Demographics
NPI:1265191340
Name:LUSK, SOPHIA (RBT)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
Last Name:LUSK
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 SOURCE LN
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:VA
Mailing Address - Zip Code:22642-5233
Mailing Address - Country:US
Mailing Address - Phone:540-683-0290
Mailing Address - Fax:
Practice Address - Street 1:130 CARRIEBROOKE DR
Practice Address - Street 2:
Practice Address - City:STEPHENS CITY
Practice Address - State:VA
Practice Address - Zip Code:22655-6000
Practice Address - Country:US
Practice Address - Phone:540-486-4653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-15
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer