1780656231 NPI number — MR. TAD DEAN LEUSCH MS, ATC, LAT

Table of content: MR. TAD DEAN LEUSCH MS, ATC, LAT (NPI 1780656231)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780656231 NPI number — MR. TAD DEAN LEUSCH MS, ATC, LAT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEUSCH
Provider First Name:
TAD
Provider Middle Name:
DEAN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MS, ATC, LAT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780656231
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 482
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TIFFIN
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52340-0482
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-335-9507
Provider Business Mailing Address Fax Number:
319-335-8126

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 STADIUM DRIVE
Provider Second Line Business Practice Location Address:
40 JACOBSEN ATHLETIC BUILDING
Provider Business Practice Location Address City Name:
IOWA CITY
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52242
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-335-9507
Provider Business Practice Location Address Fax Number:
319-995-8126
Provider Enumeration Date:
02/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X , with the licence number:  00556 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com