Provider Demographics
NPI:1053893594
Name:BECKER, BYRON (PTA)
Entity type:Individual
Prefix:
First Name:BYRON
Middle Name:
Last Name:BECKER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 AMARANTE
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-8929
Mailing Address - Country:US
Mailing Address - Phone:425-736-7255
Mailing Address - Fax:
Practice Address - Street 1:12 AMARANTE
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-8929
Practice Address - Country:US
Practice Address - Phone:425-736-7255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-31
Last Update Date:2018-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant