Provider Demographics
NPI:1538817622
Name:BECKER, MARYSSA LEIGHANNE (PT, DPT)
Entity type:Individual
Prefix:
First Name:MARYSSA
Middle Name:LEIGHANNE
Last Name:BECKER
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 1:5596 WIGEON ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97306-2799
Mailing Address - Country:US
Mailing Address - Phone:541-944-5292
Mailing Address - Fax:
Practice Address - Street 1:1025 2ND ST NW
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97304-4001
Practice Address - Country:US
Practice Address - Phone:503-339-7556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-17
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist