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General NPI Number Information
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NPI Number | 1508405358
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Entity Type | Individual
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Provider Name | RYAN MICHAEL UPTON DPT
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Gender | Male
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Dates
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Enumeration Date | 12/26/2019
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Last Update Date | 12/06/2021
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Provider Practice Location Address
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Address Line | 3280 E FOOTHILL BLVD
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City | PASADENA
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State | CA
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Zip | 91107-3103
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Country | US
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Telephone | 833-574-2273
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Fax |
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Provider Business Mailing Address
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Address Line | 333 GEORGIAN RD
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City | LA CANADA FLINTRIDGE
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State | CA
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Zip | 91011-3520
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Country | US
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Telephone | 818-632-4207
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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