Healthcare Provider Details

I. General information

NPI: 1235383753
Provider Name (Legal Business Name): STACIE MARIE UNDERWOOD PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2008
Last Update Date: 11/11/2021
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 SHARON AVE NW
LENOIR NC
28645-4326
US

IV. Provider business mailing address

3843 MOUNT BEULAH RD
SHERRILLS FORD NC
28673-7804
US

V. Phone/Fax

Practice location:
  • Phone: 828-758-7565
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number7924
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: