Healthcare Provider Details

I. General information

NPI: 1831029107
Provider Name (Legal Business Name): ANDREW LEITHEISER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N KROHN PL
SIOUX FALLS SD
57103-1815
US

IV. Provider business mailing address

100 N KROHN PL
SIOUX FALLS SD
57103-1815
US

V. Phone/Fax

Practice location:
  • Phone: 605-331-0588
  • Fax:
Mailing address:
  • Phone: 605-331-0588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT12195
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: