Provider Demographics
NPI:1497245625
Name:BECKER, MEGHAN ANN (PT)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:ANN
Last Name:BECKER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:ANN
Other - Last Name:MITTELSTADT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 145
Mailing Address - Street 2:
Mailing Address - City:CARLTON
Mailing Address - State:MN
Mailing Address - Zip Code:55718-0145
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:650 BIRCH ST
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:WI
Practice Address - Zip Code:54002
Practice Address - Country:US
Practice Address - Phone:715-684-3231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-14
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11059225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist