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1598185233
KENNETH BECKER
MOUNTAIN HOME AFB, ID
NPI
1598185233
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
2255A2300X Specialist/Technologist, Athletic Trainer
(Licence: ID AT-394)
Enumeration Date
2014-04-21
Last Update Date
2021-08-23
Business Address
Mr. KENNETH BECKER ATC
366 GUNFIGHTER AVE STE 498
MOUNTAIN HOME AFB, ID 83648-5258
Phone number: 208-724-4782
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Mailing Address
Mr. KENNETH BECKER ATC
133 MAGNOLIA AVE SE
FORT WALTON BEACH, FL 32548-7266
Phone number:
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