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General NPI Number Information
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NPI Number | 1902872609
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Entity Type | Individual
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Provider Name | SANDRA J UPPVALL PT
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Gender | Female
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Dates
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Enumeration Date | 02/23/2006
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Last Update Date | 05/07/2017
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Provider Practice Location Address
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Address Line | 111 KAY ST
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City | ITHACA
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State | NY
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Zip | 14850
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Country | US
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Telephone | 607-257-2743
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Fax | 607-257-5809
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Provider Business Mailing Address
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Address Line | 111 KAY ST
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City | ITHACA
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State | NY
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Zip | 14850-1703
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Country | US
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Telephone | 607-257-2743
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Fax | 607-257-5809
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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 | 012344
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 3882
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License Number State | MA
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