Provider Demographics
NPI:1558954859
Name:SMITH, ONDRE BREYON (DPT)
Entity Type:Individual
Prefix:DR
First Name:ONDRE
Middle Name:BREYON
Last Name:SMITH
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 ZENOBIA ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80219-1067
Mailing Address - Country:US
Mailing Address - Phone:720-425-2179
Mailing Address - Fax:
Practice Address - Street 1:400 S COLORADO BLVD STE 640
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CO
Practice Address - Zip Code:80246-1239
Practice Address - Country:US
Practice Address - Phone:303-320-4450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0017423225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist