Provider Demographics
NPI:1750513677
Name:BECKER, JACQUELINE LOUISE (DPT)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:LOUISE
Last Name:BECKER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 LAKESIDE PARK DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-4834
Mailing Address - Country:US
Mailing Address - Phone:760-410-8485
Mailing Address - Fax:760-593-2689
Practice Address - Street 1:182 LAKESIDE PARK DR
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-4834
Practice Address - Country:US
Practice Address - Phone:760-410-8485
Practice Address - Fax:760-593-2689
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-11
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13988225100000X
NJ40QA01322300225100000X
CA40179225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA99999999Medicaid
TN99999999Medicaid