Provider Demographics
NPI:1902817794
Name:BECKER, MONICA (PT)
Entity Type:Individual
Prefix:MS
First Name:MONICA
Middle Name:
Last Name:BECKER
Suffix:
Gender:F
Credentials:PT
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 44470
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85064-4470
Mailing Address - Country:US
Mailing Address - Phone:602-248-4470
Mailing Address - Fax:602-266-1641
Practice Address - Street 1:13575 W INDIAN SCHOOL RD
Practice Address - Street 2:700
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-4901
Practice Address - Country:US
Practice Address - Phone:623-935-5505
Practice Address - Fax:623-935-5551
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7313225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PENDINGMedicare ID - Type Unspecified