Angela K Smith DPT, LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

Legal business name

ANGELA K SMITH DPT, LLC

Practice address

135 N Main St Ste 104
Logan, UT 84321-4587

Phone

(435) 557-0709

Fax

(435) 213-2483

NPI assigned

Aug 10, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Angela Knowles Smith, DPTNPI 1427363191

Title

Owner/Ceo

Phone

(435) 229-7567

Specialties & licenses 1

Addresses

Other names 1

• Custom Physical Therapy Doing business as

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Angela Knowles Smith, DPT

  • Physical Therapist
  • Logan, UT
  • NPI 1427363191
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1628553600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635984000000",
    "number": "1508531815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "775 E 2660 N",
            "city": "NORTH LOGAN",
            "state": "UT",
            "postal_code": "843416747",
            "telephone_number": "435-229-7567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "135 N MAIN ST STE 104",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843214587",
            "telephone_number": "435-557-0709",
            "fax_number": "435-213-2483"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANGELA K SMITH DPT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-10",
        "last_updated": "2021-11-04",
        "certification_date": "2021-11-04",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_middle_name": "KNOWLES",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "435-229-7567",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Custom Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Custom Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tyler Anderson, CSW
• Ryan B Anderton, MOTR/L
• Conner Andrews
• Duncan Jo Andrus, PHARMD
• Jill R. Andrus, M.S. CCC-SLP
• Mindy Ann Anhder, RD
• Apria Healthcare LLC
• Amanda Arendt, L.AC, MSTCM, DIPL.OM
• Arthur Retirement Commmunity
• Aspen Grove Bodywork

• All providers in Logan, UT
• Physical Therapy Clinic/Center in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.