Provider Demographics
NPI:1952668634
Name:UPWARDS PEDIATRIC THERAPY
Entity Type:Organization
Organization Name:UPWARDS PEDIATRIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:LIZZA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:203-218-6988
Mailing Address - Street 1:246 HATTERTOWN RD
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06470-2445
Mailing Address - Country:US
Mailing Address - Phone:203-218-6988
Mailing Address - Fax:203-459-4249
Practice Address - Street 1:240 COLONY ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5205
Practice Address - Country:US
Practice Address - Phone:203-292-8452
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007056225100000X
CT003071225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty