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General NPI Number Information
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NPI Number | 1689210726
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Entity Type | Individual
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Provider Name | AMANDA LEIGH LUSKY ATC
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Gender | Female
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Dates
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Enumeration Date | 11/25/2019
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Last Update Date | 11/25/2019
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Provider Practice Location Address
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Address Line | 1 S GROVE ST
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City | WESTERVILLE
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State | OH
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Zip | 43081-2004
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Country | US
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Telephone | 614-823-3533
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Fax |
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Provider Business Mailing Address
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Address Line | 87 LANCELOT LN
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City | WESTERVILLE
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State | OH
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Zip | 43081-2825
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Country | US
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Telephone | 412-897-0016
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT005221
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License Number State | OH
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