Provider Demographics
NPI:1912583311
Name:UPGRADE BODY & HOME
Entity Type:Organization
Organization Name:UPGRADE BODY & HOME
Other - Org Name:UPGRADE BODY & HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LA TORRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-835-5444
Mailing Address - Street 1:14951 KEAVY PL
Mailing Address - Street 2:
Mailing Address - City:HAYMARKET
Mailing Address - State:VA
Mailing Address - Zip Code:20169-4979
Mailing Address - Country:US
Mailing Address - Phone:571-445-4966
Mailing Address - Fax:
Practice Address - Street 1:14951 KEAVY PL
Practice Address - Street 2:
Practice Address - City:HAYMARKET
Practice Address - State:VA
Practice Address - Zip Code:20169-4979
Practice Address - Country:US
Practice Address - Phone:571-445-4966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-24
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty