Healthcare Provider Details

I. General information

NPI: 1639783004
Provider Name (Legal Business Name): HALEY A BECKER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2020
Last Update Date: 11/17/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RANDOLPH HEALTH PHYSICAL THERAPY AND SPORTS MEDICINE 503 N FAYETTEVILLE STREET
ASHEBORO NC
27203-4728
US

IV. Provider business mailing address

218 FOUST ST STE C
ASHEBORO NC
27203-5476
US

V. Phone/Fax

Practice location:
  • Phone: 336-626-3700
  • Fax: 336-626-6453
Mailing address:
  • Phone: 336-625-2233
  • Fax: 336-625-5511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP19365
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: