Provider Demographics
NPI:1548586332
Name:BECKER, AMY WAKABAYASHI (DPT)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:WAKABAYASHI
Last Name:BECKER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 CONGRESS ST
Mailing Address - Street 2:SUITE 303
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3024
Mailing Address - Country:US
Mailing Address - Phone:858-414-6552
Mailing Address - Fax:
Practice Address - Street 1:4105 OCEAN VIEW BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:MONTROSE
Practice Address - State:CA
Practice Address - Zip Code:91020-1520
Practice Address - Country:US
Practice Address - Phone:818-792-5143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-19
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36638225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DI535ZMedicare PIN