Provider Demographics
NPI:1699775304
Name:UNDERWOOD, SUSAN L (PT)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:L
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5817 ROBERT E LEE DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-5221
Mailing Address - Country:US
Mailing Address - Phone:615-665-0177
Mailing Address - Fax:615-665-0177
Practice Address - Street 1:1195 OLD HICKORY BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-4239
Practice Address - Country:US
Practice Address - Phone:615-377-8773
Practice Address - Fax:615-377-8775
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0000000517225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist