Provider Demographics
NPI:1831656065
Name:SMITH, ANDREW ROBERT (ATS)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:ROBERT
Last Name:SMITH
Suffix:
Gender:M
Credentials:ATS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 UTA BLVD APT 128C
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-6937
Mailing Address - Country:US
Mailing Address - Phone:779-875-3618
Mailing Address - Fax:
Practice Address - Street 1:1001 UTA BLVD APT 128C
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-6937
Practice Address - Country:US
Practice Address - Phone:779-875-3618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-24
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT82402255A2300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer