Provider Demographics
NPI:1285027904
Name:BECKER, ELIZABETH S (PTA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:S
Last Name:BECKER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5608 PARKCREST DR STE 100
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4972
Mailing Address - Country:US
Mailing Address - Phone:512-345-4664
Mailing Address - Fax:512-345-6150
Practice Address - Street 1:5608 PARKCREST DR STE 100
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4972
Practice Address - Country:US
Practice Address - Phone:512-345-4664
Practice Address - Fax:512-345-6150
Is Sole Proprietor?:No
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2105258225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant