Individual
MR. NYLTON TUIBUEN BASCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
5900 W SAMPLE RD, APT 304, CORAL SPRINGS, FL 33067-3248
(954) 345-7040
Mailing address
5900 W SAMPLE RD, APT 304, CORAL SPRINGS, FL 33067-3248
(954) 345-7040
Taxonomy
Speciality
Code
Description
License number
State
2251G0304X
Geriatric Physical Therapist
Primary
12609
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
B200638761050
DRIVER'S LICENSE
FL
Enumeration date
04/29/2010
Last updated
04/29/2010
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