Provider Demographics
NPI:1578761649
Name:BECKER, KRISTA HOPE (MPT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:HOPE
Last Name:BECKER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2628
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58802-2628
Mailing Address - Country:US
Mailing Address - Phone:701-651-4325
Mailing Address - Fax:844-787-1839
Practice Address - Street 1:602 MAIN ST E
Practice Address - Street 2:
Practice Address - City:MOHALL
Practice Address - State:ND
Practice Address - Zip Code:58761-4100
Practice Address - Country:US
Practice Address - Phone:701-756-6831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2017-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1390225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1390OtherPHYSICAL THERAPY