Provider Demographics
NPI:1528431681
Name:LYSAGHT, JUSTIN (DPT)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:LYSAGHT
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 APPLEGLEN CT
Mailing Address - Street 2:
Mailing Address - City:MC DONALD
Mailing Address - State:PA
Mailing Address - Zip Code:15057-2629
Mailing Address - Country:US
Mailing Address - Phone:412-352-2976
Mailing Address - Fax:
Practice Address - Street 1:545 E BRUCETON RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15236-4593
Practice Address - Country:US
Practice Address - Phone:412-532-0144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-10
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT024879225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist