Provider Demographics
NPI:1114915642
Name:BECKHAM, JOSEPH P (DPT)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:P
Last Name:BECKHAM
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 LEEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-2506
Mailing Address - Country:US
Mailing Address - Phone:850-553-7273
Mailing Address - Fax:
Practice Address - Street 1:1618 MAHAN CENTER BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5477
Practice Address - Country:US
Practice Address - Phone:850-325-6307
Practice Address - Fax:850-325-6387
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT20953225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262475406OtherTAX IDENTIFIER
FLY123SOtherBCBS PROVIDER ID
FLU5183ZOtherMEDICARE PROVIDER NUMBER
FLU5183ZOtherMEDICARE PROVIDER NUMBER