Provider Demographics
NPI:1285736074
Name:BECK, SHEILA DENISE
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:DENISE
Last Name:BECK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1091 DUTTON MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:CENTER RIDGE
Mailing Address - State:AR
Mailing Address - Zip Code:72027-8547
Mailing Address - Country:US
Mailing Address - Phone:501-893-6418
Mailing Address - Fax:
Practice Address - Street 1:1091 DUTTON MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:CENTER RIDGE
Practice Address - State:AR
Practice Address - Zip Code:72027-8547
Practice Address - Country:US
Practice Address - Phone:501-893-6418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT 1575225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5U984OtherBLUE CROSS BLUE SHIELD