Provider Demographics
NPI:1922107614
Name:VUKSIC, MIRKO (MPT, OCS, CSCS)
Entity Type:Individual
Prefix:MR
First Name:MIRKO
Middle Name:
Last Name:VUKSIC
Suffix:
Gender:M
Credentials:MPT, OCS, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32261 CAMINO CAPISTRANO
Mailing Address - Street 2:D101
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-3746
Mailing Address - Country:US
Mailing Address - Phone:949-429-2155
Mailing Address - Fax:949-429-2151
Practice Address - Street 1:32261 CAMINO CAPISTRANO
Practice Address - Street 2:D101
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-3746
Practice Address - Country:US
Practice Address - Phone:949-429-2155
Practice Address - Fax:949-429-2151
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 272412251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW17098Medicare PIN
CAWPT27241AMedicare ID - Type UnspecifiedPPIN
CAP84985Medicare UPIN