Provider Demographics
NPI:1427530310
Name:UPTON, JOHN WILLIAM (MPT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:WILLIAM
Last Name:UPTON
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49270-9556
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:818 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1446
Practice Address - Country:US
Practice Address - Phone:517-265-0364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010761225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist