Provider Demographics
NPI:1841317872
Name:LUYSTER, RICHARD B (PT)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:B
Last Name:LUYSTER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77101 DOUGLAS TURN RD
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43973-9372
Mailing Address - Country:US
Mailing Address - Phone:740-491-0791
Mailing Address - Fax:866-274-4974
Practice Address - Street 1:77101 DOUGLAS TURN RD
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:OH
Practice Address - Zip Code:43973-9372
Practice Address - Country:US
Practice Address - Phone:740-491-0791
Practice Address - Fax:866-274-4974
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-08819225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH020579400-00OtherBWC
OH2209069Medicaid
OH000000226050OtherANTHEM BC BS
OH0205794001A00OtherBLUE CROSS BLUE SHIELD
OH0205794001A00OtherBLUE CROSS BLUE SHIELD