Provider Demographics
NPI:1801275466
Name:BECK, HARLEY GRANT (ATC)
Entity type:Individual
Prefix:
First Name:HARLEY
Middle Name:GRANT
Last Name:BECK
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3516 S RANGE LINE RD APT 6
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-4444
Mailing Address - Country:US
Mailing Address - Phone:719-349-9902
Mailing Address - Fax:
Practice Address - Street 1:3950 NEWMAN RD
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-1512
Practice Address - Country:US
Practice Address - Phone:417-625-9337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit