Provider Demographics
NPI:1083908206
Name:UPPLEGER, ELIZABETH T
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:T
Last Name:UPPLEGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:T
Other - Last Name:GLADYSZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21191 GORDON RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-1519
Mailing Address - Country:US
Mailing Address - Phone:586-943-5757
Mailing Address - Fax:
Practice Address - Street 1:18285 E 10 MILE RD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-5802
Practice Address - Country:US
Practice Address - Phone:586-774-5774
Practice Address - Fax:586-774-5884
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501003245225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist