Active NPI
Evan Robert Underwood, DPT
- Physical Therapist
- Camdenton, MO
National Provider Identifier
1528626140
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 2019016835
- Practice address
- 1930 N Business Route 5 Unit 1B
Camdenton, MO 65020-2659 - Phone
- (573) 346-7445
- NPI assigned
- May 29, 2019
- Sex
- Male
- 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 | 2019016835 | MO | Primary |
Addresses
Primary practice location
1930 N Business Route 5 Unit 1B
Camdenton, MO 65020-2659
Mailing address
10415 Redfield LN
Eugene, MO 65032
Phone (573) 380-1785
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | eunderwood@lakeregional.com |
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 |
|---|---|---|---|
| 2019016835 | MO | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1559088000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1559088000000",
"number": "1528626140",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10415 REDFIELD LN",
"city": "EUGENE",
"state": "MO",
"postal_code": "65032",
"telephone_number": "573-380-1785"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1930 N BUSINESS ROUTE 5 UNIT 1B",
"city": "CAMDENTON",
"state": "MO",
"postal_code": "650202659",
"telephone_number": "573-346-7445"
}
],
"practiceLocations": [],
"basic": {
"last_name": "UNDERWOOD",
"first_name": "EVAN",
"middle_name": "ROBERT",
"name_prefix": "Mr.",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-05-29",
"last_updated": "2019-05-29",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MO",
"license": "2019016835",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "eunderwood@lakeregional.com",
"affiliation": "N",
"endpointDescription": "work email",
"address_1": "1930 N Business Route 5 Unit 1B",
"city": "Camdenton",
"state": "MO",
"country_code": "US",
"postal_code": "650202659",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Camdenton, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.