Provider Demographics
NPI:1164852364
Name:PANNU, UPWINDER SINGH (PT)
Entity Type:Individual
Prefix:MR
First Name:UPWINDER
Middle Name:SINGH
Last Name:PANNU
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8920 BUSINESS PARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-7618
Mailing Address - Country:US
Mailing Address - Phone:512-339-1023
Mailing Address - Fax:
Practice Address - Street 1:8920 BUSINESS PARK DR STE 200
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-7618
Practice Address - Country:US
Practice Address - Phone:512-339-1023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-25
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501014616225100000X
TX1282649225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist