Provider Demographics
NPI:1972273936
Name:UNDERWOOD, LAUREN MCKENNA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:MCKENNA
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33560 BRANDON RD
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-6992
Mailing Address - Country:US
Mailing Address - Phone:909-855-5250
Mailing Address - Fax:
Practice Address - Street 1:8805 HAVEN AVE STE 110
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-5149
Practice Address - Country:US
Practice Address - Phone:909-912-1725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA301022225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist