Provider Demographics
NPI:1790842896
Name:AQUINO, BENIGNO MANALOTO (PT)
Entity Type:Individual
Prefix:
First Name:BENIGNO
Middle Name:MANALOTO
Last Name:AQUINO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1318 DEERCREEK DRIVE
Mailing Address - Street 2:
Mailing Address - City:HUMBOLDT
Mailing Address - State:IA
Mailing Address - Zip Code:50548-7706
Mailing Address - Country:US
Mailing Address - Phone:515-570-2657
Mailing Address - Fax:
Practice Address - Street 1:2700 1ST AVE S
Practice Address - Street 2:SUITE 200
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-4306
Practice Address - Country:US
Practice Address - Phone:515-955-6922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02666225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist