Provider Demographics
NPI:1417177015
Name:BECKERINK, ERIC DEAN (PTA)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:DEAN
Last Name:BECKERINK
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 PHOENIX CT
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37663-4311
Mailing Address - Country:US
Mailing Address - Phone:423-863-5315
Mailing Address - Fax:
Practice Address - Street 1:103 W STONE DR
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3220
Practice Address - Country:US
Practice Address - Phone:423-224-5751
Practice Address - Fax:423-224-5776
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPTA0000003547225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant