Provider Demographics
NPI:1811195860
Name:LECK, CHRISTOPHER M (DPT)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:M
Last Name:LECK
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:PO BOX 5718
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59903-5718
Mailing Address - Country:US
Mailing Address - Phone:855-456-7146
Mailing Address - Fax:406-309-2579
Practice Address - Street 1:200 E IDAHO ST
Practice Address - Street 2:SUITE A
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-4117
Practice Address - Country:US
Practice Address - Phone:406-756-7878
Practice Address - Fax:406-257-7811
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT11520225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP00991062OtherRR MEDICARE