Provider Demographics
NPI:1336539428
Name:BECKER, THEODORE J (PHD)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:J
Last Name:BECKER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5213 23RD AVE W
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-1557
Mailing Address - Country:US
Mailing Address - Phone:425-353-9300
Mailing Address - Fax:425-290-3688
Practice Address - Street 1:11627 AIRPORT RD STE H
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-8714
Practice Address - Country:US
Practice Address - Phone:425-353-9300
Practice Address - Fax:425-290-3688
Is Sole Proprietor?:No
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT0003086225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist