Provider Demographics
NPI:1871073015
Name:STUART, BECKY K (PT, DPT)
Entity type:Individual
Prefix:
First Name:BECKY
Middle Name:K
Last Name:STUART
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1890 JUNCTION BLVD
Mailing Address - Street 2:APT 424
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-4983
Mailing Address - Country:US
Mailing Address - Phone:510-305-5254
Mailing Address - Fax:
Practice Address - Street 1:15400 FOOTHILL BLVD BLDG H
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-1009
Practice Address - Country:US
Practice Address - Phone:510-305-5254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34426225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist