Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 1140143 | TX |
Y | 2251G0304X | Physical Therapist - Geriatrics | 1140143 | TX |
NPI | 1376024000 |
---|---|
Provider Name | Delicia Marie Bentancourt |
First Address | Frisco, TX 75035-7871 |
Second Address | Plano, TX 75093-8800 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2018 |
Last Update Date | 21/08/2018 |