Provider Demographics
NPI:1285779231
Name:BENAVIDEZ, JUAN E JR (PT)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:E
Last Name:BENAVIDEZ
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 E ALTON GLOOR BLVD
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-3361
Mailing Address - Country:US
Mailing Address - Phone:956-350-0600
Mailing Address - Fax:956-350-9966
Practice Address - Street 1:451 E ALTON GLOOR BLVD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-3361
Practice Address - Country:US
Practice Address - Phone:956-350-0600
Practice Address - Fax:956-350-9966
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1170867225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist