Provider Demographics
NPI:1053127696
Name:BERMUDEZ, NIKOLE (PT, DPT)
Entity type:Individual
Prefix:
First Name:NIKOLE
Middle Name:
Last Name:BERMUDEZ
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1290 RAVEN AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-3841
Mailing Address - Country:US
Mailing Address - Phone:305-586-6369
Mailing Address - Fax:
Practice Address - Street 1:8603 S DIXIE HWY STE 308
Practice Address - Street 2:
Practice Address - City:PINECREST
Practice Address - State:FL
Practice Address - Zip Code:33156-1129
Practice Address - Country:US
Practice Address - Phone:305-661-1441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT42483225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist