Provider Demographics
NPI:1093802977
Name:UPWARD, FIONA MARY (PT, GCFP)
Entity Type:Individual
Prefix:MRS
First Name:FIONA
Middle Name:MARY
Last Name:UPWARD
Suffix:
Gender:F
Credentials:PT, GCFP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4325
Mailing Address - Street 2:
Mailing Address - City:STAR CITY
Mailing Address - State:WV
Mailing Address - Zip Code:26504-4325
Mailing Address - Country:US
Mailing Address - Phone:304-599-3668
Mailing Address - Fax:
Practice Address - Street 1:1085 VAN VOORHIS RD
Practice Address - Street 2:SUITE 200
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3497
Practice Address - Country:US
Practice Address - Phone:304-599-9250
Practice Address - Fax:304-599-9254
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV001208225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810004443Medicaid