Healthcare Provider Details

I. General information

NPI: 1740127893
Provider Name (Legal Business Name): JOSHUA SMITH DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13733 QUAY ST NW
ANDOVER MN
55304-3620
US

IV. Provider business mailing address

10801 LANCASTER LN N
MAPLE GROVE MN
55369-2752
US

V. Phone/Fax

Practice location:
  • Phone: 736-712-7045
  • Fax:
Mailing address:
  • Phone: 651-236-7272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9773
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: