Provider Demographics
NPI:1225563224
Name:BENAVIDES, FELICIA RENEE (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:RENEE
Last Name:BENAVIDES
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:TX
Mailing Address - Zip Code:75428-3345
Mailing Address - Country:US
Mailing Address - Phone:469-226-4937
Mailing Address - Fax:
Practice Address - Street 1:2200 CAMPBELL ST
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:TX
Practice Address - Zip Code:75428-3319
Practice Address - Country:US
Practice Address - Phone:903-468-3074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-27
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT53032255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer