Provider Demographics
NPI:1164777439
Name:CHESWORTH, BECKY LYNN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:LYNN
Last Name:CHESWORTH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:BECKY
Other - Middle Name:LYNN
Other - Last Name:CHEYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:306 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79720-2429
Mailing Address - Country:US
Mailing Address - Phone:432-267-3806
Mailing Address - Fax:432-267-3809
Practice Address - Street 1:306 W 3RD ST
Practice Address - Street 2:
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-2429
Practice Address - Country:US
Practice Address - Phone:432-267-3806
Practice Address - Fax:432-267-3809
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1219141225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX021635001Medicaid
TX021635001Medicaid