Basic Information
| Provider Information | |||||||||
| NPI: | 1699775304 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | UNDERWOOD | ||||||||
| FirstName: | SUSAN | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5817 ROBERT E LEE DR | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372155221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6156650177 | ||||||||
| FaxNumber: | 6156650177 | ||||||||
| Practice Location | |||||||||
| Address1: | 1195 OLD HICKORY BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370274239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153778773 | ||||||||
| FaxNumber: | 6153778775 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT0000000517 | TN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.