Provider Demographics
NPI:1003907502
Name:SCHMIDT, TODD HAROLD (PT)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:HAROLD
Last Name:SCHMIDT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 W 1500 S
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-5147
Mailing Address - Country:US
Mailing Address - Phone:801-298-3039
Mailing Address - Fax:
Practice Address - Street 1:3785 W 10400 S STE 104
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-5650
Practice Address - Country:US
Practice Address - Phone:801-673-4430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT285255-24012251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic