Provider Demographics
NPI:1780192906
Name:BECKER, SARA (DPT)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:BECKER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:VELASCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1851 E YALE DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-2257
Mailing Address - Country:US
Mailing Address - Phone:630-550-3158
Mailing Address - Fax:
Practice Address - Street 1:2225 W SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-4716
Practice Address - Country:US
Practice Address - Phone:480-412-4101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-22
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10526225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist