Provider Demographics
NPI:1780397497
Name:EWERT, ANDREA M (PTA)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:M
Last Name:EWERT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14241 S REDWOOD RD STE A-020
Mailing Address - Street 2:
Mailing Address - City:BLUFFDALE
Mailing Address - State:UT
Mailing Address - Zip Code:84065-5223
Mailing Address - Country:US
Mailing Address - Phone:801-302-7230
Mailing Address - Fax:801-601-8245
Practice Address - Street 1:13358 S 5600 W
Practice Address - Street 2:
Practice Address - City:HERRIMAN
Practice Address - State:UT
Practice Address - Zip Code:84096
Practice Address - Country:US
Practice Address - Phone:801-302-7232
Practice Address - Fax:801-302-7237
Is Sole Proprietor?:No
Enumeration Date:2022-12-28
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT13190899-2402225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant