Provider Demographics
NPI:1588984694
Name:UNDERWOOD, LINDA (LMT)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1064 GARDNER ROAD
Mailing Address - Street 2:313
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407
Mailing Address - Country:US
Mailing Address - Phone:843-852-9939
Mailing Address - Fax:843-852-9949
Practice Address - Street 1:1064 GARDNER RD
Practice Address - Street 2:SUITE 313
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-5768
Practice Address - Country:US
Practice Address - Phone:843-852-9939
Practice Address - Fax:843-852-9949
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-11
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6248225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist