Provider Demographics
NPI:1144547167
Name:BASCO, NYLTON TUIBUEN (PT)
Entity type:Individual
Prefix:MR
First Name:NYLTON
Middle Name:TUIBUEN
Last Name:BASCO
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 1:5900 W SAMPLE RD
Mailing Address - Street 2:APT 304
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-3248
Mailing Address - Country:US
Mailing Address - Phone:954-345-7040
Mailing Address - Fax:
Practice Address - Street 1:5900 W SAMPLE RD
Practice Address - Street 2:APT 304
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-3248
Practice Address - Country:US
Practice Address - Phone:954-345-7040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC126092251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLB200638761050OtherDRIVER'S LICENSE