Basic Information
| Provider Information | |||||||||
| NPI: | 1093934218 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BECKMAN | ||||||||
| FirstName: | BRENDA | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | |||||||||
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| Credential: | A.T.,C. | ||||||||
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| OtherLastName: | BECKMAN | ||||||||
| OtherFirstName: | BRENDA | ||||||||
| OtherMiddleName: | K | ||||||||
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| OtherCredential: | A.T.,C. | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 10602 E MILLIRON RD | ||||||||
| Address2: | |||||||||
| City: | CHEYENNE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820099391 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3076384700 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5307 YELLOWSTONE RD | ||||||||
| Address2: | |||||||||
| City: | CHEYENNE | ||||||||
| State: | WY | ||||||||
| PostalCode: | 820094736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3076327677 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.