Healthcare Provider Details

I. General information

NPI: 1215698873
Provider Name (Legal Business Name): UP THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2022
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 HIGHWAY 190 APT 1422
MANDEVILLE LA
70448-3486
US

IV. Provider business mailing address

1901 HIGHWAY 190 APT 1422
MANDEVILLE LA
70448-3486
US

V. Phone/Fax

Practice location:
  • Phone: 150-438-8194
  • Fax:
Mailing address:
  • Phone: 504-388-1944
  • Fax: 504-899-5415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RENEE' BOOKER
Title or Position: OWNER
Credential: LCSW, BACS
Phone: 504-388-1944