Healthcare Provider Details

I. General information

NPI: 1346756509
Provider Name (Legal Business Name): KAYLA BECK MS, AT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2017
Last Update Date: 01/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1961 LANGRAM RD
PUT IN BAY OH
43456-6732
US

IV. Provider business mailing address

3 HORSESHOE DR
MONROEVILLE OH
44847-9707
US

V. Phone/Fax

Practice location:
  • Phone: 419-706-7775
  • Fax:
Mailing address:
  • Phone: 419-706-7775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number003926
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License Number003926
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number003926
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number003926
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code2084S0010X
TaxonomySports Medicine (Psychiatry & Neurology) Physician
License Number003926
License Number StateOH
# 6
Primary TaxonomyN
Taxonomy Code224Y00000X
TaxonomyClinical Exercise Physiologist
License Number003926
License Number StateOH
# 7
Primary TaxonomyN
Taxonomy Code226300000X
TaxonomyKinesiotherapist
License Number003926
License Number StateOH
# 8
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number003926
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: