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General NPI Number Information
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NPI Number | 1346891553
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Entity Type | Individual
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Provider Name | COURTNEY UPSHAW ATC, LAT
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Gender | Female
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Dates
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Enumeration Date | 09/28/2019
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Last Update Date | 09/28/2019
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Provider Practice Location Address
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Address Line | 4980 W SAHARA AVE STE 260
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City | LAS VEGAS
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State | NV
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Zip | 89146-3435
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Country | US
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Telephone | 610-223-5944
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Fax |
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Provider Business Mailing Address
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Address Line | 1251 S CIMARRON RD APT 29
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City | LAS VEGAS
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State | NV
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Zip | 89117-1394
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Country | US
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Telephone | 864-509-2055
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 0506533
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License Number State | NV
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