Provider Demographics
NPI:1275360398
Name:BECKER, BRIDGET J (LMT)
Entity type:Individual
Prefix:
First Name:BRIDGET
Middle Name:J
Last Name:BECKER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:BRIDGET
Other - Middle Name:J
Other - Last Name:BECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:49 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12528-1407
Mailing Address - Country:US
Mailing Address - Phone:845-416-1638
Mailing Address - Fax:
Practice Address - Street 1:49 MAIN ST
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:NY
Practice Address - Zip Code:12528-1407
Practice Address - Country:US
Practice Address - Phone:845-416-1638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-14
Last Update Date:2024-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030395-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist