Healthcare Provider Details

I. General information

NPI: 1053229294
Provider Name (Legal Business Name): RACHEL N UPSHAW LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2026
Last Update Date: 08/29/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WHITLOCK AVE NW STE 115
MARIETTA GA
30064-4665
US

IV. Provider business mailing address

9474 US HIGHWAY 78
BREMEN GA
30110-4210
US

V. Phone/Fax

Practice location:
  • Phone: 678-683-5406
  • Fax:
Mailing address:
  • Phone: 678-683-5406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License NumberMT006812
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: