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NPI Code Detail

MEDICARE: SOPHIA LUSK RBT

MEDICARE: SOPHIA LUSK RBT
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
12255A2300XAthletic Trainer

General Provider Information

NPI Number : 1265191340
Entity Type Code : Individual
Provider Name (Legal Business Name) : SOPHIA LUSK RBT
Provider Business Mailing Address
First Line : 112 SOURCE LN
Second Line :
City : LINDEN
State : VA
Zip : 22642-5233
Country : US
Telephone Number : 540-683-0290
Fax Number :
Provider Business Practice Location Address
First Line : 130 CARRIEBROOKE DR
Second Line :
City : STEPHENS CITY
State : VA
Zip : 22655-6000
Country : US
Telephone Number : 540-486-4653
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/15/2021
Last Update Date : 12/15/2021

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Directions to “ SOPHIA LUSK RBT” Practice Location

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