Provider Demographics
NPI:1841355682
Name:UPTON, STACY L (PT)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:L
Last Name:UPTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2775 DILLON RD
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-8225
Mailing Address - Country:US
Mailing Address - Phone:406-862-9378
Mailing Address - Fax:
Practice Address - Street 1:711 E 13TH ST
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-2964
Practice Address - Country:US
Practice Address - Phone:406-862-9378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT957PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist