Provider Demographics
NPI:1720248552
Name:BECNEL, JASON (MPT)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:BECNEL
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31985 LA HIGHWAY 16
Mailing Address - Street 2:STE C
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-1462
Mailing Address - Country:US
Mailing Address - Phone:225-791-7114
Mailing Address - Fax:225-791-7118
Practice Address - Street 1:8448 SIEGEN LANE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810
Practice Address - Country:US
Practice Address - Phone:225-767-8182
Practice Address - Fax:225-767-8757
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA05028225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist