Healthcare Provider Details

I. General information

NPI: 1134058357
Provider Name (Legal Business Name): RAFAEL BECERRA PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 C ST STE 130
GALT CA
95632-2802
US

IV. Provider business mailing address

408 HIGUERA ST STE 200
SAN LUIS OBISPO CA
93401-6135
US

V. Phone/Fax

Practice location:
  • Phone: 209-745-5802
  • Fax: 209-745-5574
Mailing address:
  • Phone: 805-788-0805
  • Fax: 805-788-0845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number310286
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: