Provider Demographics
NPI:1790259760
Name:BERMUDEZ, RAUL A (MS,LAT, ATC, CSCS)
Entity Type:Individual
Prefix:
First Name:RAUL
Middle Name:A
Last Name:BERMUDEZ
Suffix:
Gender:M
Credentials:MS,LAT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 S MINT ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-1518
Mailing Address - Country:US
Mailing Address - Phone:305-342-2028
Mailing Address - Fax:
Practice Address - Street 1:1410 ABBEY PL APT 115
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-3039
Practice Address - Country:US
Practice Address - Phone:305-342-2028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20000207732255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer