Provider Demographics
NPI:1164778858
Name:BERMUDEZ, CATHERINE B
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:B
Last Name:BERMUDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2233 W DIVISION ST
Mailing Address - Street 2:PHYSICAL THERAPY DEPARTMENT
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-8151
Mailing Address - Country:US
Mailing Address - Phone:312-770-2000
Mailing Address - Fax:312-770-3477
Practice Address - Street 1:12828 HARBOR BLVD STE 200
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-5834
Practice Address - Country:US
Practice Address - Phone:177-357-4545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-31
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.014456225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist