Provider Demographics
NPI:1205816147
Name:UPP, L DARRELL (PT)
Entity Type:Individual
Prefix:MR
First Name:L
Middle Name:DARRELL
Last Name:UPP
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 1:4995 BRADENTON AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-3543
Mailing Address - Country:US
Mailing Address - Phone:614-734-5000
Mailing Address - Fax:614-734-5001
Practice Address - Street 1:4995 BRADENTON AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-3543
Practice Address - Country:US
Practice Address - Phone:614-734-5000
Practice Address - Fax:614-734-5001
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT068862251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHUP4153353Medicare ID - Type Unspecified