Provider Demographics
NPI:1164679064
Name:BECK, STEVEN J (PTA)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:J
Last Name:BECK
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3878 HICKS RD
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:IL
Mailing Address - Zip Code:62807-1318
Mailing Address - Country:US
Mailing Address - Phone:618-334-5534
Mailing Address - Fax:
Practice Address - Street 1:3878 HICKS RD
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:IL
Practice Address - Zip Code:62807-1318
Practice Address - Country:US
Practice Address - Phone:618-334-5534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160002730225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant