Provider Demographics
NPI:1447647755
Name:UNDERWOOD, THOMAS N JR (ATC, LAC, MBA)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:N
Last Name:UNDERWOOD
Suffix:JR
Gender:M
Credentials:ATC, LAC, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 FOREST CIR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-3551
Mailing Address - Country:US
Mailing Address - Phone:434-548-1445
Mailing Address - Fax:434-791-5740
Practice Address - Street 1:420 W MAIN ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-3612
Practice Address - Country:US
Practice Address - Phone:434-791-7270
Practice Address - Fax:434-791-5740
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-24
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer