Healthcare Provider Details

I. General information

NPI: 1710772132
Provider Name (Legal Business Name): TEEKO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20973 CORKSCREW SHORES BLVD
ESTERO FL
33928-9146
US

IV. Provider business mailing address

20973 CORKSCREW SHORES BLVD
ESTERO FL
33928-9146
US

V. Phone/Fax

Practice location:
  • Phone: 630-687-0574
  • Fax: 239-320-3231
Mailing address:
  • Phone: 630-687-0574
  • Fax: 239-320-3231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. TYLER EMERSON MELELCKER
Title or Position: CEO
Credential: PTA
Phone: 630-687-0574