Provider Demographics
NPI:1942284054
Name:BECKETT, STEPHEN V
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:V
Last Name:BECKETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 SAINT JOHN ST STE 137
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-3024
Mailing Address - Country:US
Mailing Address - Phone:207-772-3800
Mailing Address - Fax:207-774-3510
Practice Address - Street 1:222 SAINT JOHN ST STE 137
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3024
Practice Address - Country:US
Practice Address - Phone:207-772-3800
Practice Address - Fax:207-774-3510
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT2100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
M24238OtherCIGNA
ME23670000Medicaid
236700099OtherMAINE CARE
4414946OtherAETNA
MN2258OtherHARVARD PILGRIM
025526OtherANTHEM BCBS
M51022OtherCIGNA
PT2100OtherLICENSE
4414946OtherAETNA