Healthcare Provider Details

I. General information

NPI: 1679278758
Provider Name (Legal Business Name): UPLIFT PHYSIO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2023
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 SUNSET DR
BURLINGTON MA
01803-4112
US

IV. Provider business mailing address

19 SUNSET DR
BURLINGTON MA
01803-4112
US

V. Phone/Fax

Practice location:
  • Phone: 978-761-3303
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: ALYSSA SAMUELSON
Title or Position: MANAGING MEMBER /PHYSICAL THERAPIST
Credential: PT, DPT
Phone: 978-761-3303