Provider Demographics
NPI:1760153811
Name:UNDERWOOD, GREGORY LEE
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:LEE
Last Name:UNDERWOOD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 E MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-3245
Mailing Address - Country:US
Mailing Address - Phone:740-438-3322
Mailing Address - Fax:
Practice Address - Street 1:957 BECKS KNOB RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-8800
Practice Address - Country:US
Practice Address - Phone:740-654-2634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant