Provider Demographics
NPI:1992165260
Name:UNDERWOOD, MATTHEW ADRIAN (PT, DPT)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:ADRIAN
Last Name:UNDERWOOD
Suffix:
Gender:
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2570 KINGSBROOKE LN
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-7394
Mailing Address - Country:US
Mailing Address - Phone:404-735-0857
Mailing Address - Fax:
Practice Address - Street 1:2570 KINGSBROOKE LN
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-7394
Practice Address - Country:US
Practice Address - Phone:404-735-0857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT011669225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist