Provider Demographics
NPI:1265858351
Name:BENSHUSHAN, RICA
Entity Type:Individual
Prefix:
First Name:RICA
Middle Name:
Last Name:BENSHUSHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1921 WALDEMERE ST
Mailing Address - Street 2:SUITE 609
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-2943
Mailing Address - Country:US
Mailing Address - Phone:941-917-6500
Mailing Address - Fax:941-917-6504
Practice Address - Street 1:1921 WALDEMERE ST
Practice Address - Street 2:SUITE 609
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2943
Practice Address - Country:US
Practice Address - Phone:941-917-6500
Practice Address - Fax:941-917-6504
Is Sole Proprietor?:No
Enumeration Date:2014-03-13
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA15393225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist