Provider Demographics
NPI:1962458885
Name:UNDERWOOD, ANN ELIZABETH (MSPT)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:ELIZABETH
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:ELIZABETH
Other - Last Name:BRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:3575 KEITH ST NW
Practice Address - Street 2:STE 205
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-4324
Practice Address - Country:US
Practice Address - Phone:423-559-0444
Practice Address - Fax:423-559-0103
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0446652Medicaid
TN3156797OtherBCBST - GROUP NUMBER
TN5441709Medicaid
TN446652Medicare ID - Type UnspecifiedGROUP NUMBER