MEDICARE: JAMEY L UNDERWOOD DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	P12657	NC

General Provider Information

NPI Number	:	1083933246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMEY L UNDERWOOD DPT

Provider Business Mailing Address
First Line	:	4601 PARK RD
Second Line	:	STE 300
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-2290
Country	:	US
Telephone Number	:	704-323-2000
Fax Number	:	704-945-7681

Provider Business Practice Location Address
First Line	:	2174 CHERRY ROAD
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29732-2160
Country	:	US
Telephone Number	:	803-325-8282
Fax Number	:	803-325-8283

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2010
Last Update Date	:	04/12/2018

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