Provider Demographics
NPI:1942406103
Name:SMITH, ANDREW P (PT)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:P
Last Name:SMITH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11086 DRAKE DR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-5333
Mailing Address - Country:US
Mailing Address - Phone:317-776-0240
Mailing Address - Fax:317-776-0240
Practice Address - Street 1:11086 DRAKE DR
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-5333
Practice Address - Country:US
Practice Address - Phone:317-776-0240
Practice Address - Fax:317-776-0240
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05008035A2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic