Provider Demographics
NPI:1649610387
Name:UKO, UKO MBA (DPT)
Entity type:Individual
Prefix:
First Name:UKO
Middle Name:MBA
Last Name:UKO
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 1:300 W 80TH PL
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-5456
Mailing Address - Country:US
Mailing Address - Phone:219-769-6037
Mailing Address - Fax:219-769-6113
Practice Address - Street 1:300 W 80TH PL
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5476
Practice Address - Country:US
Practice Address - Phone:219-769-6037
Practice Address - Fax:219-769-6113
Is Sole Proprietor?:No
Enumeration Date:2013-06-26
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05005368A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist