Provider Demographics
NPI:1407999568
Name:VALENCIA, ERWIN BENEDICT (MED, PT, ATC, CSCS)
Entity Type:Individual
Prefix:MR
First Name:ERWIN
Middle Name:BENEDICT
Last Name:VALENCIA
Suffix:
Gender:M
Credentials:MED, PT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4210 W GRAY ST
Mailing Address - Street 2:UNIT 1
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-2262
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1701 27TH ST E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-7831
Practice Address - Country:US
Practice Address - Phone:941-747-3031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer