Healthcare Provider Details

I. General information

NPI: 1144216979
Provider Name (Legal Business Name): DAVID YUGO PHYSICAL THERAPIST
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4455 EDISON LAKES PKWY
MISHAWAKA IN
46545-1442
US

IV. Provider business mailing address

4455 EDISON LAKES PKWY
MISHAWAKA IN
46545-1443
US

V. Phone/Fax

Practice location:
  • Phone: 574-259-1175
  • Fax: 574-259-9671
Mailing address:
  • Phone: 574-259-1175
  • Fax: 574-259-9671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05001860A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: