Provider Demographics
NPI:1184796161
Name:SUSAN UNDERWOOD PHYSICAL THERAPY
Entity type:Organization
Organization Name:SUSAN UNDERWOOD PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:UNDERWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:615-298-8021
Mailing Address - Street 1:2021 RICHARD JONES RD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-2860
Mailing Address - Country:US
Mailing Address - Phone:615-298-8021
Mailing Address - Fax:615-298-8024
Practice Address - Street 1:2021 RICHARD JONES RD
Practice Address - Street 2:SUITE 180
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37215-2860
Practice Address - Country:US
Practice Address - Phone:615-298-8021
Practice Address - Fax:615-298-8024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4110467OtherBLUE CROSS BLUE SHIELD
TN3731833Medicare ID - Type Unspecified