Provider Demographics
NPI:1801610753
Name:BOVINO, VINCENT DAYTON (DPT)
Entity type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:DAYTON
Last Name:BOVINO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1097 VIA CARILLO
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-6790
Mailing Address - Country:US
Mailing Address - Phone:818-751-4135
Mailing Address - Fax:
Practice Address - Street 1:2488 TOWNSGATE RD STE C
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-6113
Practice Address - Country:US
Practice Address - Phone:805-910-9913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-07
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA307088225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist