Provider Demographics
NPI:1558056770
Name:BECKE, JESSICA CHRISTEL ROSE
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:CHRISTEL ROSE
Last Name:BECKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3065 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MD
Mailing Address - Zip Code:21102-1832
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9815 MAIN ST STE 206
Practice Address - Street 2:
Practice Address - City:DAMASCUS
Practice Address - State:MD
Practice Address - Zip Code:20872-2099
Practice Address - Country:US
Practice Address - Phone:301-253-6761
Practice Address - Fax:301-253-6762
Is Sole Proprietor?:No
Enumeration Date:2023-04-05
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD29570225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist