Provider Demographics
NPI:1538757448
Name:BENITEZ, BRIAN RICARDO (ATC)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:RICARDO
Last Name:BENITEZ
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-3102
Mailing Address - Country:US
Mailing Address - Phone:954-376-2468
Mailing Address - Fax:859-622-8857
Practice Address - Street 1:521 LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-3102
Practice Address - Country:US
Practice Address - Phone:954-376-2468
Practice Address - Fax:859-622-8857
Is Sole Proprietor?:No
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAT16732255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer