Healthcare Provider Details

I. General information

NPI: 1023526449
Provider Name (Legal Business Name): KIRA UNDERWOOD DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2018
Last Update Date: 12/09/2021
Certification Date: 12/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8929 UNIVERSITY CENTER LN STE 200
SAN DIEGO CA
92122-1008
US

IV. Provider business mailing address

2923 LONE STAR TRL
ATLANTA GA
30340-5021
US

V. Phone/Fax

Practice location:
  • Phone: 855-543-0333
  • Fax:
Mailing address:
  • Phone: 313-995-0724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT294137
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: