Individual
MACKENZIE UNDERWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
12345 E 21ST ST N, WICHITA, KS 67206-3503
(316) 634-0909
Mailing address
1942 N WOOD CT, WICHITA, KS 67212-5321
(316) 633-3433
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
24-00789
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
41774
NATA
—
Enumeration date
11/16/2020
Last updated
11/16/2020
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