Provider Demographics
NPI:1801899752
Name:WEST, BECKY W (PT)
Entity type:Individual
Prefix:
First Name:BECKY
Middle Name:W
Last Name:WEST
Suffix:
Gender:
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 10TH ST
Mailing Address - Street 2:
Mailing Address - City:TYBEE ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31328-8807
Mailing Address - Country:US
Mailing Address - Phone:912-658-1019
Mailing Address - Fax:912-472-4352
Practice Address - Street 1:16 10TH ST
Practice Address - Street 2:
Practice Address - City:TYBEE ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31328-8807
Practice Address - Country:US
Practice Address - Phone:912-658-1019
Practice Address - Fax:912-472-4352
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT002479225100000X
FLPT 21678225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00431505DMedicaid