Healthcare Provider Details

I. General information

NPI: 1972991479
Provider Name (Legal Business Name): REBEKKA BECK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBEKKA JOHNSTON

II. Dates (important events)

Enumeration Date: 01/06/2015
Last Update Date: 01/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 REGENT DR
WARRENSBURG MO
64093-3231
US

IV. Provider business mailing address

415 LANGLEY DR
WHITEMAN AFB MO
65305-1285
US

V. Phone/Fax

Practice location:
  • Phone: 660-429-4444
  • Fax:
Mailing address:
  • Phone: 530-913-6750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2014011830
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: