Provider Demographics
NPI:1932928298
Name:UY, NINO MARK (PT)
Entity type:Individual
Prefix:
First Name:NINO
Middle Name:MARK
Last Name:UY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8167 NW GREENBANK CIR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-3044
Mailing Address - Country:US
Mailing Address - Phone:777-666-1116
Mailing Address - Fax:
Practice Address - Street 1:4745 FOUR LAKES CIR SW FL 32960
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32968-4802
Practice Address - Country:US
Practice Address - Phone:863-634-3023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-04
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT32962225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist