Healthcare Provider Details

I. General information

NPI: 1679310296
Provider Name (Legal Business Name): MARISA UPTMOR DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARISA URRUTIA DPT

II. Dates (important events)

Enumeration Date: 07/10/2024
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 N LOOP ROAD
FORT IRWIN CA
92310
US

IV. Provider business mailing address

THE NATIONAL TRAINING CENTER
APO AA
92310
US

V. Phone/Fax

Practice location:
  • Phone: 866-957-9224
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: