Provider Demographics
NPI:1871789685
Name:MONTERO, EVELYN BERMUDEZ (PT)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:BERMUDEZ
Last Name:MONTERO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23520 147TH AVE
Mailing Address - Street 2:SUITE5
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422-3293
Mailing Address - Country:US
Mailing Address - Phone:718-341-5313
Mailing Address - Fax:717-528-3534
Practice Address - Street 1:23520 147TH AVE
Practice Address - Street 2:SUITE5
Practice Address - City:ROSEDALE
Practice Address - State:NY
Practice Address - Zip Code:11422-3293
Practice Address - Country:US
Practice Address - Phone:718-341-5313
Practice Address - Fax:717-528-3534
Is Sole Proprietor?:No
Enumeration Date:2007-09-15
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020016225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist