Provider Demographics
NPI:1679310296
Name:UPTMOR, MARISA (DPT)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:UPTMOR
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MARISA
Other - Middle Name:
Other - Last Name:URRUTIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:6075 SW 27TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-3175
Mailing Address - Country:US
Mailing Address - Phone:786-201-0445
Mailing Address - Fax:
Practice Address - Street 1:2400 DEL PASO RD STE 132
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-9629
Practice Address - Country:US
Practice Address - Phone:916-886-2940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist