Provider Demographics
NPI:1598062648
Name:PAVLOVICH, ANDREW D (DPT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:D
Last Name:PAVLOVICH
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 1:2075 UNIVERSITY PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-1611
Mailing Address - Country:US
Mailing Address - Phone:801-779-6366
Mailing Address - Fax:801-779-6304
Practice Address - Street 1:2075 UNIVERSITY PARK BLVD
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041
Practice Address - Country:US
Practice Address - Phone:801-779-6366
Practice Address - Fax:801-779-6304
Is Sole Proprietor?:No
Enumeration Date:2011-02-24
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT60238892401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist