Healthcare Provider Details

I. General information

NPI: 1598955866
Provider Name (Legal Business Name): CHET M UNDERWOOD MPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 01/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RR 2 BOX 207-4
BUCKHANNON WV
26201-9527
US

IV. Provider business mailing address

RR 2 BOX 207-4
BUCKHANNON WV
26201-9527
US

V. Phone/Fax

Practice location:
  • Phone: 330-464-1400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 010751
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number2346
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: