Provider Demographics
NPI:1083178701
Name:BENAVENTE, VICTORIA (PT)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:BENAVENTE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:HUNTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4040 FAIRFAX DR STE 120
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-1613
Mailing Address - Country:US
Mailing Address - Phone:949-606-3425
Mailing Address - Fax:
Practice Address - Street 1:4040 FAIRFAX DR STE 120
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-1613
Practice Address - Country:US
Practice Address - Phone:571-877-6028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-27
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA295909225100000X
VA230514763225100000X
CO0016191225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist