Provider Demographics
NPI:1992315543
Name:TESKE, CONNOR WILLIS (DPT)
Entity type:Individual
Prefix:DR
First Name:CONNOR
Middle Name:WILLIS
Last Name:TESKE
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 1:3401 BOHNET BLVD N
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-1248
Mailing Address - Country:US
Mailing Address - Phone:701-429-3261
Mailing Address - Fax:
Practice Address - Street 1:3401 BOHNET BLVD N
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-1248
Practice Address - Country:US
Practice Address - Phone:701-429-3261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-07
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2303225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist