Provider Demographics
NPI:1346756509
Name:BECK, KAYLA (MS, AT, ATC)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:BECK
Suffix:
Gender:F
Credentials:MS, AT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 HORSESHOE DR
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44847-9707
Mailing Address - Country:US
Mailing Address - Phone:419-706-7775
Mailing Address - Fax:
Practice Address - Street 1:1961 LANGRAM RD
Practice Address - Street 2:
Practice Address - City:PUT IN BAY
Practice Address - State:OH
Practice Address - Zip Code:43456-6732
Practice Address - Country:US
Practice Address - Phone:419-706-7775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-22
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH003926204C00000X, 207PS0010X, 207ZP0102X, 2081S0010X, 2084S0010X, 224Y00000X, 226300000X, 2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
No207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports MedicineGroup - Multi-Specialty
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
No2084S0010XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySports Medicine
No224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist
No226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist