Provider Demographics
NPI:1558412908
Name:BECKER, TRISHA ANN (PT, DPT, MHS, OCS)
Entity Type:Individual
Prefix:
First Name:TRISHA
Middle Name:ANN
Last Name:BECKER
Suffix:
Gender:F
Credentials:PT, DPT, MHS, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 S BEMISTON AVE
Mailing Address - Street 2:SUITE 404
Mailing Address - City:CLAYTON
Mailing Address - State:MO
Mailing Address - Zip Code:63105-1913
Mailing Address - Country:US
Mailing Address - Phone:314-727-8887
Mailing Address - Fax:314-727-8893
Practice Address - Street 1:130 S BEMISTON AVE
Practice Address - Street 2:SUITE 404
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-1913
Practice Address - Country:US
Practice Address - Phone:314-727-8887
Practice Address - Fax:314-727-8893
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-14
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO100606225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist