Provider Demographics
NPI:1225663107
Name:ATHENA PELVIC THERAPY
Entity Type:Organization
Organization Name:ATHENA PELVIC THERAPY
Other - Org Name:ATHENA PELVIC THERAPY, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENEDICT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:352-449-6906
Mailing Address - Street 1:1169 STONEHAM DR
Mailing Address - Street 2:
Mailing Address - City:GROVELAND
Mailing Address - State:FL
Mailing Address - Zip Code:34736-8308
Mailing Address - Country:US
Mailing Address - Phone:352-449-6906
Mailing Address - Fax:
Practice Address - Street 1:738 8TH ST
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-2158
Practice Address - Country:US
Practice Address - Phone:352-449-6906
Practice Address - Fax:321-231-7904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-11
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty