Active NPI
Liberty D Underwood, PTA
- Physical Therapy Assistant
- Adrian, MO
National Provider Identifier
1760615389
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 2009016644
- Practice address
- 402 W 1St St
Adrian, MO 64720-9277 - Phone
- (816) 297-2107
- NPI assigned
- Aug 30, 2009
- 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 Therapy Assistant | 225200000X | 2009016644 | MO | Primary |
Addresses
Primary practice location
402 W 1St St
Adrian, MO 64720-9277
Mailing address
RR 2 Box 205
Adrian, MO 64720-9408
Phone (816) 297-8968
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 |
|---|---|---|---|
| 2009016644 | MO | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1251590400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1251590400000",
"number": "1760615389",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "RR 2 BOX 205",
"city": "ADRIAN",
"state": "MO",
"postal_code": "647209408",
"telephone_number": "816-297-8968"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "402 W 1ST ST",
"city": "ADRIAN",
"state": "MO",
"postal_code": "647209277",
"telephone_number": "816-297-2107"
}
],
"practiceLocations": [],
"basic": {
"last_name": "UNDERWOOD",
"first_name": "LIBERTY",
"middle_name": "D",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-08-30",
"last_updated": "2009-08-30",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "MO",
"license": "2009016644",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Adrian, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.