Provider Demographics
NPI:1245450030
Name:BENITO-REFUGIO, MAY (PT)
Entity type:Individual
Prefix:MRS
First Name:MAY
Middle Name:
Last Name:BENITO-REFUGIO
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 1:5627 HALLIE RAE LN
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-8199
Mailing Address - Country:US
Mailing Address - Phone:812-230-5700
Mailing Address - Fax:812-917-2127
Practice Address - Street 1:5627 HALLIE RAE LN
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-8199
Practice Address - Country:US
Practice Address - Phone:812-230-5700
Practice Address - Fax:812-917-2127
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05003052A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200818050Medicaid
IN234680BMedicare ID - Type Unspecified