Healthcare Provider Details

I. General information

NPI: 1154206977
Provider Name (Legal Business Name): CALEB JOSEPH LUSK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 ROBERTSON BLVD
WALTERBORO SC
29488-2952
US

IV. Provider business mailing address

2014 LANCASTER PL
PIERRE SD
57501-4901
US

V. Phone/Fax

Practice location:
  • Phone: 843-538-2055
  • Fax:
Mailing address:
  • Phone: 605-222-1994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6183
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCPO51491T
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCPO48544T
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: