Individual
BREANNA LUECKING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
208 ZACHERY DR, MOUNT VERNON, IL 62864-6712
(618) 731-4007
Mailing address
672 WOODS LN, CENTRALIA, IL 62801-4966
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
IL
Other
Enumeration date
07/13/2021
Last updated
07/13/2021
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