Provider Demographics
NPI:1508201435
Name:FLORENTIN, BENEDICT INLAYO (RPT)
Entity Type:Individual
Prefix:
First Name:BENEDICT
Middle Name:INLAYO
Last Name:FLORENTIN
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 W MONTANA AVE
Mailing Address - Street 2:
Mailing Address - City:BONIFAY
Mailing Address - State:FL
Mailing Address - Zip Code:32425-1515
Mailing Address - Country:US
Mailing Address - Phone:646-399-5272
Mailing Address - Fax:
Practice Address - Street 1:503 W MONTANA AVE
Practice Address - Street 2:
Practice Address - City:BONIFAY
Practice Address - State:FL
Practice Address - Zip Code:32425-1515
Practice Address - Country:US
Practice Address - Phone:646-399-5272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 27336225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400116861Medicare PIN