Provider Demographics
NPI:1407970072
Name:UPWARD THERAPY, L.L.C.
Entity Type:Organization
Organization Name:UPWARD THERAPY, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:G
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:770-265-2474
Mailing Address - Street 1:921 RICHMOND HILL DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-4442
Mailing Address - Country:US
Mailing Address - Phone:770-265-2474
Mailing Address - Fax:770-518-0331
Practice Address - Street 1:921 RICHMOND HILL DR
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-4442
Practice Address - Country:US
Practice Address - Phone:770-265-2474
Practice Address - Fax:770-518-0331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005376225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00923546BMedicaid