Provider Demographics
NPI:1326393844
Name:BECK, BRIANNA M
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:M
Last Name:BECK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 BRINDLEY LN
Mailing Address - Street 2:
Mailing Address - City:CENTER RIDGE
Mailing Address - State:AR
Mailing Address - Zip Code:72027-8454
Mailing Address - Country:US
Mailing Address - Phone:501-289-0446
Mailing Address - Fax:
Practice Address - Street 1:6 BRINDLEY LN
Practice Address - Street 2:
Practice Address - City:CENTER RIDGE
Practice Address - State:AR
Practice Address - Zip Code:72027-8454
Practice Address - Country:US
Practice Address - Phone:501-289-0446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-20
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT 3299225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR193182721Medicaid