Provider Demographics
NPI:1437330495
Name:BENEMERITO, ALVIN ORTEGA (RPT)
Entity Type:Individual
Prefix:MR
First Name:ALVIN
Middle Name:ORTEGA
Last Name:BENEMERITO
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 38
Mailing Address - Street 2:621 NORTH MAIN ST
Mailing Address - City:LONG PINE
Mailing Address - State:NE
Mailing Address - Zip Code:69217-0038
Mailing Address - Country:US
Mailing Address - Phone:402-273-3164
Mailing Address - Fax:413-431-5660
Practice Address - Street 1:102 E SOUTH ST
Practice Address - Street 2:RCH REHAB DEPARTMENT
Practice Address - City:BASSETT
Practice Address - State:NE
Practice Address - Zip Code:68714-5508
Practice Address - Country:US
Practice Address - Phone:402-684-3366
Practice Address - Fax:413-431-5660
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE1353225100000X
SD0932225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist