Provider Demographics
NPI:1326460106
Name:BECKWITH, JOHN FULLER (PT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:FULLER
Last Name:BECKWITH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 E 18TH AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4081
Mailing Address - Country:US
Mailing Address - Phone:541-344-1038
Mailing Address - Fax:541-344-1605
Practice Address - Street 1:74 E 18TH AVE STE 10
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401
Practice Address - Country:US
Practice Address - Phone:541-344-1038
Practice Address - Fax:541-344-1605
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-13
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR06353225100000X
OR6353225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist