Provider Demographics
NPI:1780863837
Name:UPTON, TERESA KAY
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:KAY
Last Name:UPTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4510 65TH ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95820-3326
Mailing Address - Country:US
Mailing Address - Phone:916-549-8219
Mailing Address - Fax:
Practice Address - Street 1:3112 O ST STE 14
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-6534
Practice Address - Country:US
Practice Address - Phone:916-549-8219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist