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NPI Code Detail

MEDICARE: MARIA BECK MS, LAT, ATC, CSCS

MEDICARE: MARIA BECK MS, LAT, ATC, CSCS
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
12255A2300XAthletic Trainer

General Provider Information

NPI Number : 1760889273
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIA BECK MS, LAT, ATC, CSCS
Provider Business Mailing Address
First Line : 2211 RIVERSIDE AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55454-1350
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2211 RIVERSIDE AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55454-1350
Country : US
Telephone Number : 763-498-3190
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/26/2014
Last Update Date : 08/11/2017

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