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General NPI Number Information
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NPI Number | 1528626140
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Entity Type | Individual
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Provider Name | EVAN ROBERT UNDERWOOD DPT
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Gender | Male
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Dates
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Enumeration Date | 05/29/2019
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Last Update Date | 05/29/2019
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Provider Practice Location Address
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Address Line | 1930 N BUSINESS ROUTE 5 UNIT 1B
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City | CAMDENTON
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State | MO
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Zip | 65020-2659
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Country | US
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Telephone | 573-346-7445
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Fax |
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Provider Business Mailing Address
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Address Line | 10415 REDFIELD LN
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City | EUGENE
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State | MO
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Zip | 65032
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Country | US
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Telephone | 573-380-1785
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2019016835
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License Number State | MO
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