Provider Demographics
NPI:1083933246
Name:UNDERWOOD, JAMEY L (DPT)
Entity Type:Individual
Prefix:
First Name:JAMEY
Middle Name:L
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:JAMEY
Other - Middle Name:L
Other - Last Name:MCCOMBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:4601 PARK RD
Mailing Address - Street 2:STE 300
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-2290
Mailing Address - Country:US
Mailing Address - Phone:704-323-2000
Mailing Address - Fax:704-945-7681
Practice Address - Street 1:2174 CHERRY ROAD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-2160
Practice Address - Country:US
Practice Address - Phone:803-325-8282
Practice Address - Fax:803-325-8283
Is Sole Proprietor?:No
Enumeration Date:2010-05-26
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP12657225100000X
SC6603225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2506152Medicare PIN
NCQ41609AMedicare PIN