Provider Demographics
NPI:1093934218
Name:BECKMAN, BRENDA K (AT,C)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:K
Last Name:BECKMAN
Suffix:
Gender:F
Credentials:AT,C
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:K
Other - Last Name:BECKMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AT,C
Mailing Address - Street 1:10602 E MILLIRON RD
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-9391
Mailing Address - Country:US
Mailing Address - Phone:307-638-4700
Mailing Address - Fax:
Practice Address - Street 1:5307 YELLOWSTONE RD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-4736
Practice Address - Country:US
Practice Address - Phone:307-632-7677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer