Individual
MRS. JOHNNA RENEE UNDERWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
459 FARMERS LOOP RD, FAIRBANKS, AK 99712-1406
(907) 550-0587
Mailing address
1600 COLLEGE RD, FAIRBANKS, AK 99709-4173
(907) 457-3711
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
613
AK
Other
Enumeration date
08/27/2012
Last updated
08/27/2012
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