Provider Demographics
NPI:1144216979
Name:YUGO, DAVID (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:YUGO
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4455 EDISON LAKES PKWY
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-1443
Mailing Address - Country:US
Mailing Address - Phone:574-259-1175
Mailing Address - Fax:574-259-9671
Practice Address - Street 1:4455 EDISON LAKES PKWY
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-1442
Practice Address - Country:US
Practice Address - Phone:574-259-1175
Practice Address - Fax:574-259-9671
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05001860A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000093750OtherBC/BS
IN139990Medicare ID - Type Unspecified
IN000000093750OtherBC/BS