Provider Demographics
NPI:1336400084
Name:UGBINAR, BO VINCENT (PT)
Entity Type:Individual
Prefix:
First Name:BO
Middle Name:VINCENT
Last Name:UGBINAR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:BO
Other - Middle Name:VINCENT
Other - Last Name:UGBINAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:416 EAST 30TH ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-3934
Mailing Address - Country:US
Mailing Address - Phone:410-889-0727
Mailing Address - Fax:410-889-0729
Practice Address - Street 1:416 E 30TH ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-3934
Practice Address - Country:US
Practice Address - Phone:410-889-0727
Practice Address - Fax:410-889-0729
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-30
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23945225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist