Provider Demographics
NPI:1023526449
Name:UNDERWOOD, KIRA (DPT)
Entity type:Individual
Prefix:
First Name:KIRA
Middle Name:
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2923 LONE STAR TRL
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30340-5021
Mailing Address - Country:US
Mailing Address - Phone:313-995-0724
Mailing Address - Fax:
Practice Address - Street 1:8929 UNIVERSITY CENTER LN STE 200
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-1008
Practice Address - Country:US
Practice Address - Phone:855-543-0333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-19
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT294137225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist