Healthcare Provider Details

I. General information

NPI: 1487366456
Provider Name (Legal Business Name): BENEDICTO OCBINA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2022
Last Update Date: 12/21/2022
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1370 CELEBRATION BLVD
KISSIMMEE FL
34747-5546
US

IV. Provider business mailing address

14416 YAKIMA TRL
ORLANDO FL
32837-5475
US

V. Phone/Fax

Practice location:
  • Phone: 407-870-1561
  • Fax:
Mailing address:
  • Phone: 407-257-6961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT4827
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: