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NPI Code Detail

MEDICARE: MICHAEL ESARE-BECKSON

MEDICARE: MICHAEL ESARE-BECKSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist20200333857MO

General Provider Information

NPI Number : 1972100535
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL ESARE-BECKSON
Provider Business Mailing Address
First Line : 4433 PERSHING AVE APT 302
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63108-2512
Country : US
Telephone Number : 269-697-3891
Fax Number :
Provider Business Practice Location Address
First Line : 11278 SCHUETZ RD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63146-4957
Country : US
Telephone Number : 314-991-4066
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/07/2020
Last Update Date : 10/07/2020

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