Healthcare Provider Details

I. General information

NPI: 1104709583
Provider Name (Legal Business Name): LAUREN ELIZABETH BECKETT PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2025
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

748 S MAIN ST
CHEBOYGAN MI
49721-2220
US

IV. Provider business mailing address

687 N M 33 HWY
CHEBOYGAN MI
49721-8204
US

V. Phone/Fax

Practice location:
  • Phone: 231-627-4364
  • Fax:
Mailing address:
  • Phone: 231-445-2337
  • Fax: 231-445-2337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502008829
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: