Provider Demographics
NPI:1376573485
Name:ADMIRE, BECKY (PT)
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:
Last Name:ADMIRE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 SERGEANT SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:SERGEANT BLUFF
Mailing Address - State:IA
Mailing Address - Zip Code:51054-7729
Mailing Address - Country:US
Mailing Address - Phone:712-943-2500
Mailing Address - Fax:712-943-5696
Practice Address - Street 1:319 SERGEANT SQUARE DR
Practice Address - Street 2:
Practice Address - City:SERGEANT BLUFF
Practice Address - State:IA
Practice Address - Zip Code:51054-7729
Practice Address - Country:US
Practice Address - Phone:712-943-2500
Practice Address - Fax:712-943-5696
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1151225100000X
NE1045225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
46130OtherWELLMARKBCBS OF IOWA
IAI12173Medicare PIN
R30000Medicare UPIN