Healthcare Provider Details

I. General information

NPI: 1104015809
Provider Name (Legal Business Name): MARY ANGELA UPLINGER LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2007
Last Update Date: 10/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 BONCROFT DR
WEST SENECA NY
14224-2850
US

IV. Provider business mailing address

203 BONCROFT DR
WEST SENECA NY
14224-2850
US

V. Phone/Fax

Practice location:
  • Phone: 716-674-3956
  • Fax:
Mailing address:
  • Phone: 716-674-3956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number017072-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: