Provider Demographics
NPI:1780928705
Name:LUSNIA, EMILY SUZANNE (DPT)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:SUZANNE
Last Name:LUSNIA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:SUZANNE
Other - Last Name:BOYETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:746 E AURORA RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:MACEDONIA
Mailing Address - State:OH
Mailing Address - Zip Code:44056-2732
Mailing Address - Country:US
Mailing Address - Phone:330-908-0039
Mailing Address - Fax:330-908-0211
Practice Address - Street 1:746 E AURORA RD
Practice Address - Street 2:SUITE 7
Practice Address - City:MACEDONIA
Practice Address - State:OH
Practice Address - Zip Code:44056-2732
Practice Address - Country:US
Practice Address - Phone:330-908-0039
Practice Address - Fax:330-908-0211
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2014-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT014057225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH149440Medicare Oscar/Certification