Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | 1914 |
NPI | 1760048516 |
---|---|
Provider Name | Ashley Underwood |
First Address | Gulfport, MS 39507-2731 |
Second Address | Biloxi, MS 39531-2410 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2019 |
Last Update Date | 17/05/2019 |