Healthcare Provider Details

I. General information

NPI: 1346798782
Provider Name (Legal Business Name): JOSEPH BRANDON BECK PT, DPT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2016
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 STILLWATER CIRCLE
BONAIRE GA
31005
US

IV. Provider business mailing address

101 STILLWATER CIRCLE
BONAIRE GA
31005
US

V. Phone/Fax

Practice location:
  • Phone: 478-293-1680
  • Fax: 478-293-1685
Mailing address:
  • Phone: 478-293-1680
  • Fax: 478-293-1685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT014676
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT003042
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: