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General NPI Number Information
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NPI Number | 1912583311
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Entity Type | Organization
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Legal Business Name | UPGRADE BODY & HOME
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Dates
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Enumeration Date | 03/24/2021
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Last Update Date | 04/09/2021
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Provider Practice Location Address
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Address Line | 14951 KEAVY PL
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City | HAYMARKET
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State | VA
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Zip | 20169-4979
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Country | US
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Telephone | 571-445-4966
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Fax |
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Provider Business Mailing Address
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Address Line | 14951 KEAVY PL
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City | HAYMARKET
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State | VA
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Zip | 20169-4979
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Country | US
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Telephone | 571-445-4966
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Fax |
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MRS. NATALIE DE LA TORRE
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Credential |
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Telephone | 561-835-5444
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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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