Basic Information
| Provider Information | |||||||||
| NPI: | 1093802977 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | UPWARD | ||||||||
| FirstName: | FIONA | ||||||||
| MiddleName: | MARY | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | P.T., G.C.F.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4325 | ||||||||
| Address2: | |||||||||
| City: | STAR CITY | ||||||||
| State: | WV | ||||||||
| PostalCode: | 265044325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045993668 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1085 VAN VOORHIS RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MORGANTOWN | ||||||||
| State: | WV | ||||||||
| PostalCode: | 265053497 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3045999250 | ||||||||
| FaxNumber: | 3045999254 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 001208 | WV | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 3810004443 | 05 | WV | MEDICAID |