Healthcare Provider Details

I. General information

NPI: 1336107077
Provider Name (Legal Business Name): AMY KAY BECKEN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 04/02/2020
Certification Date: 04/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 STATE AVENUE
FARIBAULT MN
55021
US

IV. Provider business mailing address

35 STATE AVE
FARIBAULT MN
55021-6368
US

V. Phone/Fax

Practice location:
  • Phone: 507-332-0166
  • Fax: 507-332-8069
Mailing address:
  • Phone: 507-497-3790
  • Fax: 507-497-3722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6739
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: