Active NPI
Johnna Renee Underwood, PT
- Physical Therapist
- Fairbanks, AK
National Provider Identifier
1053669853
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 613
- Practice address
- 459 Farmers Loop Rd
Fairbanks, AK 99712-1406 - Phone
- (907) 550-0587
- NPI assigned
- Aug 27, 2012
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 613 | AK | Primary |
Addresses
Primary practice location
459 Farmers Loop Rd
Fairbanks, AK 99712-1406
Mailing address
1600 College Rd
Fairbanks, AK 99709-4173
Phone (907) 457-3711
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 613 | AK | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Obfc LLC | Physical Therapist | Current | Accepting new patients |
Locations
376 Layla Ct
Fairbanks, AK 99712
Phone (901) 456-1571
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1346025600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1346025600000",
"number": "1053669853",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1600 COLLEGE RD",
"city": "FAIRBANKS",
"state": "AK",
"postal_code": "997094173",
"telephone_number": "907-457-3711"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "459 FARMERS LOOP RD",
"city": "FAIRBANKS",
"state": "AK",
"postal_code": "997121406",
"telephone_number": "907-550-0587"
}
],
"practiceLocations": [],
"basic": {
"last_name": "UNDERWOOD",
"first_name": "JOHNNA",
"middle_name": "RENEE",
"name_prefix": "Mrs.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-08-27",
"last_updated": "2012-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "AK",
"license": "613",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairbanks, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.