Healthcare Provider Details

I. General information

NPI: 1427363191
Provider Name (Legal Business Name): ANGELA KNOWLES SMITH DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANGELA KNOWLES

II. Dates (important events)

Enumeration Date: 08/18/2010
Last Update Date: 11/17/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 N MAIN ST STE 104
LOGAN UT
84321-4587
US

IV. Provider business mailing address

775 E 2660 N
NORTH LOGAN UT
84341-6747
US

V. Phone/Fax

Practice location:
  • Phone: 435-229-7567
  • Fax: 435-213-2483
Mailing address:
  • Phone: 435-229-7567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number7670960-2401
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: