Healthcare Provider Details

I. General information

NPI: 1427227115
Provider Name (Legal Business Name): YUGO PHYSICALTHERAPY & SPORTS REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2008
Last Update Date: 06/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4455 EDISON LAKES PKWY SUITE 200A
MISHAWAKA IN
46545-1443
US

IV. Provider business mailing address

4455 EDISON LAKES PKWY SUITE 200A
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 Number
License Number State

VIII. Authorized Official

Name: MR. DAVE YUGO
Title or Position: PRESIDENT
Credential:
Phone: 574-259-1175