Healthcare Provider Details

I. General information

NPI: 1083040893
Provider Name (Legal Business Name): MEGAN LAUREN LUSBY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2013
Last Update Date: 09/10/2021
Certification Date: 09/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 BRYAN STATION RD STE 122
LEXINGTON KY
40505-2139
US

IV. Provider business mailing address

1650 BRYAN STATION RD STE 122
LEXINGTON KY
40505-2139
US

V. Phone/Fax

Practice location:
  • Phone: 592-936-1338
  • Fax: 859-293-6730
Mailing address:
  • Phone: 859-293-6133
  • Fax: 859-293-6730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTT28680
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number007955
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: