Provider Demographics
NPI:1427318914
Name:BESARIO, CONSOLACION A (RPT)
Entity type:Individual
Prefix:MRS
First Name:CONSOLACION
Middle Name:A
Last Name:BESARIO
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3208 SAND WOOD DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46628-6146
Mailing Address - Country:US
Mailing Address - Phone:574-277-5593
Mailing Address - Fax:
Practice Address - Street 1:3208 SAND WOOD DR
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46628-6146
Practice Address - Country:US
Practice Address - Phone:574-277-5593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-18
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05003596A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist