Provider Demographics
NPI:1134329675
Name:SMITH, ZENDRIE ANDINO (PT)
Entity Type:Individual
Prefix:
First Name:ZENDRIE
Middle Name:ANDINO
Last Name:SMITH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ZENDRIE
Other - Middle Name:
Other - Last Name:ANDINO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:16319 HEATHROW DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2640
Mailing Address - Country:US
Mailing Address - Phone:813-966-4011
Mailing Address - Fax:
Practice Address - Street 1:16319 HEATHROW DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-2640
Practice Address - Country:US
Practice Address - Phone:813-966-4011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1392225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1392OtherPHYSICAL THERAPY LICENSE
NJ40QA00760000OtherPHYSICAL THERAPY LICENSE