Provider Demographics
NPI:1942982129
Name:BECKETT, TABIA (LMT)
Entity Type:Individual
Prefix:
First Name:TABIA
Middle Name:
Last Name:BECKETT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 NAVY PIER CT UNIT 2008
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-5416
Mailing Address - Country:US
Mailing Address - Phone:347-913-6769
Mailing Address - Fax:
Practice Address - Street 1:7 NAVY PIER CT UNIT 2008
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-5416
Practice Address - Country:US
Practice Address - Phone:347-913-6769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027750225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty