Provider Demographics
NPI:1033989256
Name:BECK, KRISTI BREE (CMT)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:BREE
Last Name:BECK
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23420 PORCINA WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:CA
Mailing Address - Zip Code:95310-9715
Mailing Address - Country:US
Mailing Address - Phone:209-400-2155
Mailing Address - Fax:
Practice Address - Street 1:23420 PORCINA WAY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:CA
Practice Address - Zip Code:95310-9715
Practice Address - Country:US
Practice Address - Phone:209-400-2155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA94379225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist