Provider Demographics
NPI:1669723599
Name:LUECK, DANIELLE ELIZABETH (MS, LAT, NASM-PES)
Entity type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:ELIZABETH
Last Name:LUECK
Suffix:
Gender:F
Credentials:MS, LAT, NASM-PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 BRADDOCK RD
Mailing Address - Street 2:CORDTS PE BUILDING
Mailing Address - City:FROSTBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21532-2303
Mailing Address - Country:US
Mailing Address - Phone:301-697-9603
Mailing Address - Fax:301-687-3251
Practice Address - Street 1:101 BRADDOCK RD
Practice Address - Street 2:CORDTS PE BUILDING
Practice Address - City:FROSTBURG
Practice Address - State:MD
Practice Address - Zip Code:21532-2303
Practice Address - Country:US
Practice Address - Phone:301-697-9603
Practice Address - Fax:301-687-3251
Is Sole Proprietor?:No
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA001522255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer