Provider Demographics
NPI:1013456581
Name:ABESTANO, MARIA BABANTO
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:BABANTO
Last Name:ABESTANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIA MONICA
Other - Middle Name:CORUNA
Other - Last Name:BABANTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4715 SUMMERFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-2855
Mailing Address - Country:US
Mailing Address - Phone:850-902-1134
Mailing Address - Fax:
Practice Address - Street 1:4715 SUMMERFIELD CIR
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-2855
Practice Address - Country:US
Practice Address - Phone:850-902-1134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-17
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 24534225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist