Provider Demographics
NPI:1841437118
Name:UNDERWOOD, PAUL E (PT)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:E
Last Name:UNDERWOOD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3843 MOUNT BEULAH RD
Mailing Address - Street 2:
Mailing Address - City:SHERRILLS FORD
Mailing Address - State:NC
Mailing Address - Zip Code:28673-7804
Mailing Address - Country:US
Mailing Address - Phone:838-662-0605
Mailing Address - Fax:949-561-5267
Practice Address - Street 1:3843 MOUNT BEULAH RD
Practice Address - Street 2:
Practice Address - City:SHERRILLS FORD
Practice Address - State:NC
Practice Address - Zip Code:28673-7804
Practice Address - Country:US
Practice Address - Phone:888-624-1644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-08
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP2647225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP2647OtherLICENSE