Provider Demographics
NPI:1043307937
Name:BECKER, KELLI (PTA)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:BECKER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 404480
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-4480
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:700 E BEARDSLEY AVE
Practice Address - Street 2:STE 100
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-3366
Practice Address - Country:US
Practice Address - Phone:574-206-8010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant