Healthcare Provider Details

I. General information

NPI: 1063323558
Provider Name (Legal Business Name): EVAN BECKER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14111 WHITE CREEK AVE NE STE J
CEDAR SPRINGS MI
49319-8169
US

IV. Provider business mailing address

7199 KALAMAZOO AVE SE STE 234
CALEDONIA MI
49316-7362
US

V. Phone/Fax

Practice location:
  • Phone: 616-256-8664
  • Fax:
Mailing address:
  • Phone: 616-608-9979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501304724
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: