Andrew Jimin Gottfredson, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

13980561-2401 Issued in UT

Practice address

3303 N University Ave
Provo, UT 84604-4438

Phone

(801) 373-7438

Fax

(801) 373-7486

NPI assigned

Jul 15, 2024

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Spine Orthopedic and Sports Physical Therapy LLCGroup PAC ID 1850320805, 11 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Spine Orthopedic & Sports Physical Therapy LLC

  • Physical Therapy Clinic/Center
  • Provo, UT
  • NPI 1447275946

  Physical Therapist

  Medicare reassignment Care Compare group NPD
• Fyzical Audiology LLC

  • Audiologist
  • Provo, UT
  • NPI 1841819992
  NPD

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

{
    "created_epoch": "1721001600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721001600000",
    "number": "1861230922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9070 W CHEYENNE AVE STE 100",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891298935",
            "telephone_number": "702-268-7213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3303 N UNIVERSITY AVE",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846044438",
            "telephone_number": "801-373-7438",
            "fax_number": "801-373-7486"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOTTFREDSON",
        "first_name": "ANDREW",
        "middle_name": "JIMIN",
        "name_prefix": "Dr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-07-15",
        "last_updated": "2024-07-15",
        "certification_date": "2024-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "UT",
            "license": "13980561-2401",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gordon J. Christensen DDS PHD PC
• Christopher Gordon, D.O.
• Christopher R. Gordon, M.D.
• Robert James Gordon, SSW
• Jade Goring
• Nathan Jacob Gottfredson, MD
• Autumn Gould
• Anthony Goulding
• Zachary Dan Goulding
• George C Gourley, DO

• Physical Therapist in Provo, UT
• Providers in Provo, UT by specialty
• Physical Therapist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.