Provider Demographics
NPI:1750585386
Name:ELIZABETH L. UPTON, MSPT LLC
Entity type:Organization
Organization Name:ELIZABETH L. UPTON, MSPT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:LAWLER
Authorized Official - Last Name:TYNAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:203-218-6988
Mailing Address - Street 1:303 LINWOOD AVE
Mailing Address - Street 2:UNIT 1C
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-4900
Mailing Address - Country:US
Mailing Address - Phone:203-218-6988
Mailing Address - Fax:203-459-4249
Practice Address - Street 1:303 LINWOOD AVE
Practice Address - Street 2:UNIT 1C
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-4900
Practice Address - Country:US
Practice Address - Phone:203-218-6988
Practice Address - Fax:203-459-4249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT007056261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1750585386OtherGROUP NPI
CTC03714OtherGROUP PIN
CT1316015928OtherNPI
CT650001421Medicare PIN