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General NPI Number Information
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NPI Number | 1780552141
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Entity Type | Individual
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Provider Name | EDGAR ALLAN LIWANAG BENUSA PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 10/27/2025
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Last Update Date | 10/27/2025
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Provider Practice Location Address
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Address Line | 1580 SAWGRASS CORPORATE PKWY STE 320
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City | SUNRISE
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State | FL
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Zip | 33323-2859
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Country | US
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Telephone | 954-739-4247
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Fax |
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Provider Business Mailing Address
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Address Line | 1580 SAWGRASS CORPORATE PKWY STE 320
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City | SUNRISE
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State | FL
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Zip | 33323-2859
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Country | US
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Telephone | 432-386-6623
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1353630
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License Number State | TX
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