Provider Demographics
NPI:1134178775
Name:UNDERWOOD, REBECCA M (PT)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:M
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 MAIN ST STE 6
Mailing Address - Street 2:
Mailing Address - City:COLEBROOK
Mailing Address - State:NH
Mailing Address - Zip Code:03576-2000
Mailing Address - Country:US
Mailing Address - Phone:603-237-9300
Mailing Address - Fax:603-237-9320
Practice Address - Street 1:118 MAIN ST STE 6
Practice Address - Street 2:
Practice Address - City:COLEBROOK
Practice Address - State:NH
Practice Address - Zip Code:03576
Practice Address - Country:US
Practice Address - Phone:603-237-9300
Practice Address - Fax:603-237-9320
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2018-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0991225100000X
MA6587225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3100959Medicaid
NHRE8568Medicare UPIN
MAUN RE0621Medicare ID - Type UnspecifiedMEDICARE B