Provider Demographics
NPI:1598995706
Name:BENAVIDES, GEORGANNA CAROLINE (PT)
Entity Type:Individual
Prefix:
First Name:GEORGANNA
Middle Name:CAROLINE
Last Name:BENAVIDES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3133 W ALBERTA RD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-9402
Mailing Address - Country:US
Mailing Address - Phone:956-630-2305
Mailing Address - Fax:956-630-2704
Practice Address - Street 1:815 MARKET ST
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77550-2725
Practice Address - Country:US
Practice Address - Phone:409-770-6682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-22
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11740802251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics