Provider Demographics
NPI:1285350546
Name:BECKER, MCKENZIE LAUREN (DPT)
Entity type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:LAUREN
Last Name:BECKER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1259 HICKORY SPGS
Mailing Address - Street 2:
Mailing Address - City:WILLOW CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78675-2001
Mailing Address - Country:US
Mailing Address - Phone:503-559-1764
Mailing Address - Fax:
Practice Address - Street 1:2712 BEE CAVES RD STE 122A
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-5662
Practice Address - Country:US
Practice Address - Phone:512-335-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61014607225100000X
TX1325941225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist