Provider Demographics
NPI:1285259101
Name:SIMON, ANDREW (PT, DPT)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:SIMON
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3665 S 8400 W
Mailing Address - Street 2:STE 210
Mailing Address - City:MAGNA
Mailing Address - State:UT
Mailing Address - Zip Code:84044-4909
Mailing Address - Country:US
Mailing Address - Phone:801-250-6733
Mailing Address - Fax:801-250-5038
Practice Address - Street 1:3665 S 8400 W STE 210
Practice Address - Street 2:
Practice Address - City:MAGNA
Practice Address - State:UT
Practice Address - Zip Code:84044-4909
Practice Address - Country:US
Practice Address - Phone:801-250-6733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-16
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11739301-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist