Provider Demographics
NPI:1639183031
Name:BECKHAM, MICHAEL D (DPT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:D
Last Name:BECKHAM
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:57 S BROADVIEW ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:GREENBRIER
Mailing Address - State:AR
Mailing Address - Zip Code:72058-9231
Mailing Address - Country:US
Mailing Address - Phone:501-679-1295
Mailing Address - Fax:501-679-6806
Practice Address - Street 1:57 S BROADVIEW ST
Practice Address - Street 2:SUITE 105
Practice Address - City:GREENBRIER
Practice Address - State:AR
Practice Address - Zip Code:72058-9231
Practice Address - Country:US
Practice Address - Phone:501-679-1295
Practice Address - Fax:501-679-6806
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT2706225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5Y097OtherBCBS
AR210054721Medicaid
AR710857801OtherQUALCHOICE
ARA002OtherTRICARE
AR210054721Medicaid