Provider Demographics
NPI:1154760890
Name:SWARTZ, MARY POLIVICK (PT)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:POLIVICK
Last Name:SWARTZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 KIRKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-3222
Mailing Address - Country:US
Mailing Address - Phone:270-873-7495
Mailing Address - Fax:
Practice Address - Street 1:1507 KIRKWOOD DR
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-3222
Practice Address - Country:US
Practice Address - Phone:270-873-7495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-16
Last Update Date:2013-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY003902225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist