Provider Demographics
NPI:1427189109
Name:SMITH, ANDREA JILL (DPT)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:JILL
Last Name:SMITH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:JILL
Other - Last Name:WOODY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:769 E. PARKER LN
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106
Mailing Address - Country:US
Mailing Address - Phone:801-244-9205
Mailing Address - Fax:
Practice Address - Street 1:769 PARKER LN
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-1743
Practice Address - Country:US
Practice Address - Phone:801-244-9205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4950588-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist