Provider Demographics
NPI:1467116772
Name:BECKTON, CARLA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:BECKTON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:
Other - Last Name:ORTIZ ALVAREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:336 BROAD ST STE 203
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-3006
Mailing Address - Country:US
Mailing Address - Phone:407-380-0357
Mailing Address - Fax:407-380-0342
Practice Address - Street 1:11543 LAKE UNDERHILL RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-5001
Practice Address - Country:US
Practice Address - Phone:407-380-0357
Practice Address - Fax:407-380-0342
Is Sole Proprietor?:No
Enumeration Date:2021-10-25
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT38803225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist