Provider Demographics
NPI:1538908926
Name:LEUCK, TERESA (DPT)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:LEUCK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 7TH ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-4661
Mailing Address - Country:US
Mailing Address - Phone:605-716-6474
Mailing Address - Fax:605-716-6484
Practice Address - Street 1:425 N ELLSWORTH RD STE 2
Practice Address - Street 2:
Practice Address - City:BOX ELDER
Practice Address - State:SD
Practice Address - Zip Code:57719-2008
Practice Address - Country:US
Practice Address - Phone:605-716-6474
Practice Address - Fax:605-716-6484
Is Sole Proprietor?:No
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD6070225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist