Provider Demographics
NPI:1578869186
Name:BECKER, GERRY JOSEPH (LMT)
Entity Type:Individual
Prefix:MR
First Name:GERRY
Middle Name:JOSEPH
Last Name:BECKER
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 HANFIELD ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45223-1962
Mailing Address - Country:US
Mailing Address - Phone:513-591-2942
Mailing Address - Fax:
Practice Address - Street 1:1845 HANFIELD ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45223-1962
Practice Address - Country:US
Practice Address - Phone:513-591-2942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-28
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.009947 A-B172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist