Individual
TYRA N LUSK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
250 BENS TRL, FORT WORTH, TX 76120-7000
(817) 514-1544
Mailing address
250 BENS TRL, FORT WORTH, TX 76120-7000
(817) 514-1544
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
—
—
Other
Enumeration date
11/04/2020
Last updated
11/04/2020
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