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General NPI Number Information
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NPI Number | 1750585386
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Entity Type | Organization
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Legal Business Name | ELIZABETH L. UPTON, MSPT LLC
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Dates
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Enumeration Date | 06/14/2007
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Last Update Date | 04/16/2013
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Provider Practice Location Address
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Address Line | 303 LINWOOD AVE UNIT 1C
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City | FAIRFIELD
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State | CT
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Zip | 06824-4900
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Country | US
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Telephone | 203-218-6988
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Fax | 203-459-4249
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Provider Business Mailing Address
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Address Line | 303 LINWOOD AVE UNIT 1C
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City | FAIRFIELD
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State | CT
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Zip | 06824-4900
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Country | US
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Telephone | 203-218-6988
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Fax | 203-459-4249
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | MS. ELIZABETH LAWLER TYNAN
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Credential | PT
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Telephone | 203-218-6988
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 007056
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License Number State | CT
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