Provider Demographics
NPI:1174825830
Name:CASON, BENITA (MMP)
Entity type:Individual
Prefix:MS
First Name:BENITA
Middle Name:
Last Name:CASON
Suffix:
Gender:F
Credentials:MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1596
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-1596
Mailing Address - Country:US
Mailing Address - Phone:727-460-4696
Mailing Address - Fax:813-814-1747
Practice Address - Street 1:3608 MERIDEN AVE APT B
Practice Address - Street 2:
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-5748
Practice Address - Country:US
Practice Address - Phone:727-460-4696
Practice Address - Fax:813-814-1747
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA56217225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist