Provider Demographics
NPI:1316529217
Name:BECKMAN, CAYLEE ANN (DPT, PT, LAT, ATC)
Entity type:Individual
Prefix:
First Name:CAYLEE
Middle Name:ANN
Last Name:BECKMAN
Suffix:
Gender:F
Credentials:DPT, PT, LAT, ATC
Other - Prefix:
Other - First Name:CAYLEE
Other - Middle Name:ANN
Other - Last Name:KOKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT, PT, LAT, ATC
Mailing Address - Street 1:PO BOX 735044
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-5044
Mailing Address - Country:US
Mailing Address - Phone:800-326-2250
Mailing Address - Fax:
Practice Address - Street 1:9000 W SURA LN
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53228-3477
Practice Address - Country:US
Practice Address - Phone:414-246-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-21
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2255A2300X
WI16486225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100274442Medicaid