Provider Demographics
NPI:1578898102
Name:BECK, HEIDI (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:
Last Name:BECK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:HEIDI
Other - Middle Name:
Other - Last Name:SODERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:5610 HAMPTON PARK DR
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-4004
Mailing Address - Country:US
Mailing Address - Phone:770-289-1505
Mailing Address - Fax:
Practice Address - Street 1:5610 HAMPTON PARK DR
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-4004
Practice Address - Country:US
Practice Address - Phone:770-289-1505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-15
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9802225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist