Provider Demographics
NPI:1578814448
Name:BECKMAN, TANYA WILLIAMS (PT)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:WILLIAMS
Last Name:BECKMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4010 NW DALE DR
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-2902
Mailing Address - Country:US
Mailing Address - Phone:541-738-6626
Mailing Address - Fax:
Practice Address - Street 1:4010 NW DALE DR
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-2902
Practice Address - Country:US
Practice Address - Phone:541-738-6626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4506225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist