Provider Demographics
NPI:1700815438
Name:BAGASAN, BENSON P (PT)
Entity Type:Individual
Prefix:MR
First Name:BENSON
Middle Name:P
Last Name:BAGASAN
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 1:2746 POINTE CIR
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33413-2153
Mailing Address - Country:US
Mailing Address - Phone:561-308-1370
Mailing Address - Fax:561-469-2181
Practice Address - Street 1:2746 POINTE CIR
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33413-2153
Practice Address - Country:US
Practice Address - Phone:561-308-1370
Practice Address - Fax:561-469-2181
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8860225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist