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General NPI Number Information
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NPI Number | 1669907259
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Entity Type | Individual
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Provider Name | BENJAMIN CORDERO BERNARDO DPT
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Gender | Male
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Dates
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Enumeration Date | 04/21/2017
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Last Update Date | 04/21/2017
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Provider Practice Location Address
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Address Line | 5666 E STATE ST
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City | ROCKFORD
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State | IL
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Zip | 61108-2425
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Country | US
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Telephone | 815-395-5165
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Fax |
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Provider Business Mailing Address
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Address Line | 6338 LAUREL CHERRY DR
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City | ROCKFORD
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State | IL
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Zip | 61108-1582
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070009210
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License Number State | IL
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