Doctor Name: | JENNIFER ANNE UPHAM |
NPI Number: | 1124407929 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PTA |
License Number: | PTA0003392 |
Business Practice Address: | 4216 Bridlecreek Dr Nw Acworth, GA - 301013872 |
Business Phone Number: | 4044294012 |
Business Fax Number: | |
Mailing Address: | 4216 Bridlecreek Dr Nw, ACWORTH |
State: | GA |
Postal Code: | 301013872 |
Phone Number: | 4044294012 |
Fax Number: | |
NPI Enumeration Date: | 05/26/2015 |
NPI Last Update Date: | 05/26/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2251G0304X |
License Number: | PTA0003392 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Physical Therapist |
Taxonomy Specialization: | Geriatrics |
Taxonomy Definition: |