Healthcare Provider Details

I. General information

NPI: 1801007414
Provider Name (Legal Business Name): TAWIAH SHUKURA UPTON D.P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 14TH AVE SE
DECATUR AL
35601-4364
US

IV. Provider business mailing address

107 LAZARETTO CT
HARVEST AL
35749-4007
US

V. Phone/Fax

Practice location:
  • Phone: 256-355-6911
  • Fax:
Mailing address:
  • Phone: 404-514-8351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT007889
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTH11773
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: