Healthcare Provider Details

I. General information

NPI: 1538486519
Provider Name (Legal Business Name): MATTHEW RONALD BECKER DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2010
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JEFFERSON BARRACKS RD
SAINT LOUIS MO
63125-4181
US

IV. Provider business mailing address

1 JEFFERSON BARRACKS RD
SAINT LOUIS MO
63125-4181
US

V. Phone/Fax

Practice location:
  • Phone: 314-894-6619
  • Fax:
Mailing address:
  • Phone: 314-894-6619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5745
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: