Provider Demographics
NPI:1427227115
Name:YUGO PHYSICALTHERAPY & SPORTS REHAB
Entity Type:Organization
Organization Name:YUGO PHYSICALTHERAPY & SPORTS REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:YUGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-259-1175
Mailing Address - Street 1:4455 EDISON LAKES PKWY
Mailing Address - Street 2:SUITE 200A
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:SUITE 200A
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-1443
Practice Address - Country:US
Practice Address - Phone:574-259-1175
Practice Address - Fax:574-259-9671
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN139990Medicare PIN