Provider Demographics
NPI:1780656231
Name:LEUSCH, TAD DEAN (MS, ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:TAD
Middle Name:DEAN
Last Name:LEUSCH
Suffix:
Gender:M
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 482
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:IA
Mailing Address - Zip Code:52340-0482
Mailing Address - Country:US
Mailing Address - Phone:319-335-9507
Mailing Address - Fax:319-335-8126
Practice Address - Street 1:1 STADIUM DRIVE
Practice Address - Street 2:40 JACOBSEN ATHLETIC BUILDING
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242
Practice Address - Country:US
Practice Address - Phone:319-335-9507
Practice Address - Fax:319-995-8126
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA005562255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer