Provider Demographics
NPI:1609838788
Name:UNDERWOOD, JOSHUA KEITH (ATC)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:KEITH
Last Name:UNDERWOOD
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 PEBBLEBROOK RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VIEW
Mailing Address - State:UT
Mailing Address - Zip Code:84404-2808
Mailing Address - Country:US
Mailing Address - Phone:802-579-4444
Mailing Address - Fax:
Practice Address - Street 1:2150 PEBBLEBROOK RD
Practice Address - Street 2:
Practice Address - City:PLEASANT VIEW
Practice Address - State:UT
Practice Address - Zip Code:84404-2808
Practice Address - Country:US
Practice Address - Phone:802-579-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAT8862255A2300X
UT11890894-48102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer