Provider Demographics
NPI:1194845529
Name:BECKER, KIMBERLY (PT, ATC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:BECKER
Suffix:
Gender:F
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6313 PINNACLE CIR
Mailing Address - Street 2:
Mailing Address - City:MOUNT OLIVE
Mailing Address - State:AL
Mailing Address - Zip Code:35117-3653
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1581 MONTGOMERY HWY
Practice Address - Street 2:SUITE 115
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35216-4521
Practice Address - Country:US
Practice Address - Phone:205-874-6765
Practice Address - Fax:205-900-8160
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6023225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist