Provider Demographics
NPI:1598793895
Name:BECKER, JULIE L (PTA)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:L
Last Name:BECKER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1512 NE 96TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-1348
Mailing Address - Country:US
Mailing Address - Phone:816-792-0775
Mailing Address - Fax:816-792-0776
Practice Address - Street 1:1512 NE 96TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-1348
Practice Address - Country:US
Practice Address - Phone:816-792-0775
Practice Address - Fax:816-792-0776
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001014022225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant