Individual
BENJAMIN LUSK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
30544 ID-200, PONDERAY, ID 83852
(208) 205-9559
(808) 431-4244
Mailing address
30544 ID-200, STE 326, PONDERAY, ID 83852
(208) 205-9559
(808) 421-4244
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
6229
ID
225100000X
Physical Therapist
P15158
NC
Other
Enumeration date
08/01/2014
Last updated
01/10/2025
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