Provider Demographics
NPI:1629524640
Name:CUERVO Y BENNETT, MARIA INMACULADA (ATC)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:INMACULADA
Last Name:CUERVO Y BENNETT
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4207 ROLLING OAK DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-1286
Mailing Address - Country:US
Mailing Address - Phone:863-255-9953
Mailing Address - Fax:
Practice Address - Street 1:1 CAMINO SANTA MARIA ST
Practice Address - Street 2:ATHLETIC TRAINING DEPARTMENT
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-5433
Practice Address - Country:US
Practice Address - Phone:210-431-5043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL46862255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer