Active NPI
Brenna Underwood, LMT
- Massage Therapist
- Fort Wayne, IN
National Provider Identifier
1003525890
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- MT22207714
- Practice address
- 101 Three Rivers N # 112
Fort Wayne, IN 46802-1312 - Phone
- (260) 710-0873
- NPI assigned
- Nov 21, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | MT22207714 | IN | Primary |
Addresses
Primary practice location
101 Three Rivers N # 112
Fort Wayne, IN 46802-1312
Mailing address
101 Three Rivers N # 112
Fort Wayne, IN 46802-1312
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MT22207714 | IN | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1668988800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1752796800000",
"number": "1003525890",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 THREE RIVERS N # 112",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468021312"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 THREE RIVERS N # 112",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468021312",
"telephone_number": "260-710-0873"
}
],
"practiceLocations": [],
"basic": {
"last_name": "UNDERWOOD",
"first_name": "BRENNA",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-11-21",
"last_updated": "2025-07-18",
"certification_date": "2025-07-18",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "IN",
"license": "MT22207714",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.