Individual
MR. KENNETH BECKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
366 GUNFIGHTER AVE STE 498, MOUNTAIN HOME AFB, ID 83648-5258
(208) 724-4782
Mailing address
133 MAGNOLIA AVE SE, FORT WALTON BEACH, FL 32548-7266
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT-394
ID
Other
Enumeration date
04/21/2014
Last updated
08/23/2021
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