Individual
LISA DAWN UPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1001 S HILTON ST, BOISE, ID 83705-1925
(208) 392-7926
Mailing address
607 S HAWTHORNE AVE, EMMETT, ID 83617-3633
(208) 392-7926
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA 433
ID
Other
Enumeration date
06/17/2008
Last updated
06/17/2008
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