Healthcare Provider Details

I. General information

NPI: 1669023941
Provider Name (Legal Business Name): NATHAN BECKER DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2019
Last Update Date: 06/08/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 VASSAR ST
ORLANDO FL
32804-4920
US

IV. Provider business mailing address

727 VASSAR ST
ORLANDO FL
32804-4920
US

V. Phone/Fax

Practice location:
  • Phone: 407-492-5701
  • Fax: 407-407-9002
Mailing address:
  • Phone: 407-492-5701
  • Fax: 407-407-9002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT35109
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: