MEDICARE: MRS. SARAH DEWIT LUSK PT, OCS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PTH4012	AL

General Provider Information

NPI Number	:	1770579393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SARAH DEWIT LUSK PT, OCS

Provider Business Mailing Address
First Line	:	618 MCMEANS AVE
Second Line	:
City	:	BAY MINETTE
State	:	AL
Zip	:	36507-3333
Country	:	US
Telephone Number	:	251-937-4700
Fax Number	:	251-937-4708

Provider Business Practice Location Address
First Line	:	2115 HAND AVE
Second Line	:
City	:	BAY MINETTE
State	:	AL
Zip	:	36507-4149
Country	:	US
Telephone Number	:	251-937-2823
Fax Number	:	251-937-2821

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	04/07/2011

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