Provider Demographics
NPI:1891014734
Name:DIBENEDETTO, ARMANDO JOHN (LMT)
Entity type:Individual
Prefix:MR
First Name:ARMANDO
Middle Name:JOHN
Last Name:DIBENEDETTO
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1809 TOWN CENTER BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-4322
Mailing Address - Country:US
Mailing Address - Phone:904-278-3878
Mailing Address - Fax:904-579-4270
Practice Address - Street 1:1809 TOWN CENTER BLVD STE 3
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-4322
Practice Address - Country:US
Practice Address - Phone:904-278-3878
Practice Address - Fax:904-579-4270
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-18
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA54075225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist