Provider Demographics
NPI:1801821384
Name:BECKMAN, CODI (PTA)
Entity Type:Individual
Prefix:
First Name:CODI
Middle Name:
Last Name:BECKMAN
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:PO BOX 2020
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:WY
Mailing Address - Zip Code:82501-0274
Mailing Address - Country:US
Mailing Address - Phone:307-857-7074
Mailing Address - Fax:307-857-1072
Practice Address - Street 1:911 FLAG DR
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-2312
Practice Address - Country:US
Practice Address - Phone:307-857-7074
Practice Address - Fax:307-857-1072
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPTA - 455225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant