Provider Demographics
NPI:1720530348
Name:PIGEON, ANDREA MARIE (MS, ATC, CSCS, EMT-B)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MARIE
Last Name:PIGEON
Suffix:
Gender:F
Credentials:MS, ATC, CSCS, EMT-B
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3870 STADIUM WAY
Mailing Address - Street 2:DEPT. 2701
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84408-5149
Mailing Address - Country:US
Mailing Address - Phone:801-626-7128
Mailing Address - Fax:
Practice Address - Street 1:3870 STADIUM WAY
Practice Address - Street 2:DEPT. 2701
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84408-5149
Practice Address - Country:US
Practice Address - Phone:801-626-7128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-31
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2013086013146N00000X
UT8344028-48102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic