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Individual

ADELE UPSHAW

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
P.T.

Contact information

Practice address
1923 FARMERVILLE HWY, RUSTON, LA 71270-3007
(318) 255-9601
Mailing address
191 SANCTUARY RD, RUSTON, LA 71270-1716
(318) 255-9601

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
02155F
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1169234
LA
Enumeration date
11/16/2009
Last updated
11/16/2009
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