Provider Demographics
NPI:1023396256
Name:BECKNER, ELIZABETH
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BECKNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ANNE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 790126
Mailing Address - Street 2:DEPT 30706
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63179-0126
Mailing Address - Country:US
Mailing Address - Phone:314-205-8858
Mailing Address - Fax:314-205-2113
Practice Address - Street 1:1585 WOODLAKE DR
Practice Address - Street 2:SUITE 214
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-5740
Practice Address - Country:US
Practice Address - Phone:314-205-8858
Practice Address - Fax:314-205-2113
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011020341225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist