=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477285013
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UPWARD MOBILITY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2022
-----------------------------------------------------
Last Update Date | 06/30/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 340 DORSET ST STE 1
-----------------------------------------------------
City | SOUTH BURLINGTON
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05403-6306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-495-0817
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 340 DORSET ST STE 1
-----------------------------------------------------
City | SOUTH BURLINGTON
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05403-6306
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-495-0817
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER
-----------------------------------------------------
Name | MISS MATTHEW PETERSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 802-522-7659
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------