MEDICARE: KRISTI BREE BECK CMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	94379	CA

General Provider Information

NPI Number	:	1033989256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTI BREE BECK CMT

Provider Business Mailing Address
First Line	:	23420 PORCINA WAY
Second Line	:
City	:	COLUMBIA
State	:	CA
Zip	:	95310-9715
Country	:	US
Telephone Number	:	209-400-2155
Fax Number	:

Provider Business Practice Location Address
First Line	:	23420 PORCINA WAY
Second Line	:
City	:	COLUMBIA
State	:	CA
Zip	:	95310-9715
Country	:	US
Telephone Number	:	209-400-2155
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2024
Last Update Date	:	01/08/2024

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