Provider Demographics
NPI:1316266935
Name:BECKHAM, RICHARD MORGAN (DPT)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:MORGAN
Last Name:BECKHAM
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 DEER HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:GRENADA
Mailing Address - State:MS
Mailing Address - Zip Code:38901-4439
Mailing Address - Country:US
Mailing Address - Phone:662-207-2608
Mailing Address - Fax:
Practice Address - Street 1:702 HIGHWAY 82 W
Practice Address - Street 2:SUITE B
Practice Address - City:GREENWOOD
Practice Address - State:MS
Practice Address - Zip Code:38930-5069
Practice Address - Country:US
Practice Address - Phone:662-455-5010
Practice Address - Fax:662-455-5468
Is Sole Proprietor?:No
Enumeration Date:2010-05-21
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT4384225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist