Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | LPT-31440 | AZ |
NPI | 1538776489 |
---|---|
Provider Name | Dr. Justin Becker |
First Address | Scottsdale, AZ 85254-3950 |
Second Address | Scottsdale, AZ 85254-3950 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2020 |
Last Update Date | 24/09/2020 |