MEDICARE: PAUL E. UNDERWOOD PT

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	P2647	NC
2	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P2647	OTHER	NC	LICENSE

General Provider Information

NPI Number	:	1841437118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL E. UNDERWOOD PT

Provider Business Mailing Address
First Line	:	3843 MOUNT BEULAH RD
Second Line	:
City	:	SHERRILLS FORD
State	:	NC
Zip	:	28673-7804
Country	:	US
Telephone Number	:	838-662-0605
Fax Number	:	949-561-5267

Provider Business Practice Location Address
First Line	:	3843 MOUNT BEULAH RD
Second Line	:
City	:	SHERRILLS FORD
State	:	NC
Zip	:	28673-7804
Country	:	US
Telephone Number	:	888-624-1644
Fax Number	:

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

Provider Enumeration Date	:	01/08/2009
Last Update Date	:	09/10/2021

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