Provider Demographics
NPI:1639783004
Name:BECKER, HALEY A (DPT)
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:A
Last Name:BECKER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 FOUST ST STE C
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-5476
Mailing Address - Country:US
Mailing Address - Phone:336-625-2233
Mailing Address - Fax:336-625-5511
Practice Address - Street 1:RANDOLPH HEALTH PHYSICAL THERAPY AND SPORTS MEDICINE
Practice Address - Street 2:503 N FAYETTEVILLE STREET
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-4728
Practice Address - Country:US
Practice Address - Phone:336-626-3700
Practice Address - Fax:336-626-6453
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-03
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP19365225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1639783004Medicaid