Provider Demographics
NPI:1073988812
Name:BECKER, ANNA (PTA)
Entity Type:Individual
Prefix:
First Name:ANNA
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 1:1355 RTE. 22A
Mailing Address - Street 2:
Mailing Address - City:PANTON
Mailing Address - State:VT
Mailing Address - Zip Code:05491
Mailing Address - Country:US
Mailing Address - Phone:802-759-2984
Mailing Address - Fax:
Practice Address - Street 1:1355 ROUTE 22A
Practice Address - Street 2:
Practice Address - City:PANTON
Practice Address - State:VT
Practice Address - Zip Code:05491
Practice Address - Country:US
Practice Address - Phone:802-759-2984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-04
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT041.0000264225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant