Provider Demographics
NPI:1710949094
Name:BECK, WAYNE ALAN III (MSH, ATC, CHES)
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:ALAN
Last Name:BECK
Suffix:III
Gender:M
Credentials:MSH, ATC, CHES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:121 B 13TH AVE., S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250
Mailing Address - Country:US
Mailing Address - Phone:904-476-1226
Mailing Address - Fax:
Practice Address - Street 1:3536 PHILLIPS HWY
Practice Address - Street 2:BUILDING A, SUITE 106
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-5612
Practice Address - Country:US
Practice Address - Phone:904-202-5806
Practice Address - Fax:904-202-5587
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 16842255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer