Provider Demographics
NPI:1689810921
Name:BERTIN, CLIFF (LPTA)
Entity Type:Individual
Prefix:
First Name:CLIFF
Middle Name:
Last Name:BERTIN
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3160 N CAMBRIDGE AVE
Mailing Address - Street 2:APT. 406
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-6831
Mailing Address - Country:US
Mailing Address - Phone:773-344-5953
Mailing Address - Fax:
Practice Address - Street 1:3160 N CAMBRIDGE AVE
Practice Address - Street 2:APT. 406
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-6831
Practice Address - Country:US
Practice Address - Phone:773-344-5953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-16
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.004591225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant