Provider Demographics
NPI:1356628176
Name:BERMUDEZ, CINDY (PTA)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:
Last Name:BERMUDEZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 BENTLEY DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12182-9722
Mailing Address - Country:US
Mailing Address - Phone:617-947-5311
Mailing Address - Fax:
Practice Address - Street 1:5 BENTLEY DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12182-9722
Practice Address - Country:US
Practice Address - Phone:617-947-5311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160005237225200000X
NY007081-1225200000X
FLPTA21932225200000X
WAP160156334225200000X
CA9393225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant