Provider Demographics
NPI:1033763933
Name:JIM D. FERMO PHD
Entity Type:Organization
Organization Name:JIM D. FERMO PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:D
Authorized Official - Last Name:FERMO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:818-326-9499
Mailing Address - Street 1:19934 LUBAO PL
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-1818
Mailing Address - Country:US
Mailing Address - Phone:818-326-9499
Mailing Address - Fax:818-368-7670
Practice Address - Street 1:19934 LUBAO PL
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-1818
Practice Address - Country:US
Practice Address - Phone:818-326-9499
Practice Address - Fax:818-368-7670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-29
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty