Provider Demographics
NPI:1326507724
Name:UNDERHILL, ANNELISE DANIELLE (ATC, LAT, NREMT)
Entity Type:Individual
Prefix:
First Name:ANNELISE
Middle Name:DANIELLE
Last Name:UNDERHILL
Suffix:
Gender:F
Credentials:ATC, LAT, NREMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6501 CHESAPEAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23513-1998
Mailing Address - Country:US
Mailing Address - Phone:434-534-2752
Mailing Address - Fax:
Practice Address - Street 1:6501 CHESAPEAKE BLVD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23513-1998
Practice Address - Country:US
Practice Address - Phone:434-534-2752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-15
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260037002255A2300X, 2255A2300X
VA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program