Provider Demographics
NPI:1225294291
Name:TEECE, DANIEL LEE (DPT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:LEE
Last Name:TEECE
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 1:7581 9TH ST N STE 100
Mailing Address - Street 2:
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-6635
Mailing Address - Country:US
Mailing Address - Phone:651-748-4338
Mailing Address - Fax:
Practice Address - Street 1:110 1ST ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-1503
Practice Address - Country:US
Practice Address - Phone:715-227-5702
Practice Address - Fax:715-227-5703
Is Sole Proprietor?:No
Enumeration Date:2008-07-30
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11061-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OU018TEOtherBCBS MN
B17211055892OtherPREFERRED ONE
WIP00636189OtherRR MEDICARE
64-09024OtherMEDICA
B17211055892OtherPREFERRED ONE