Provider Demographics
NPI:1790309730
Name:BERMUDEZ, CHRISTIAN (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:
Last Name:BERMUDEZ
Suffix:
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3091 AMBERSWEET PL
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-9559
Mailing Address - Country:US
Mailing Address - Phone:832-506-9356
Mailing Address - Fax:
Practice Address - Street 1:5454 N HAVERHILL RD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-3006
Practice Address - Country:US
Practice Address - Phone:832-506-9356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL47312255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer