Provider Demographics
NPI:1194998054
Name:SWANSON, SALLY C (DPT)
Entity type:Individual
Prefix:MISS
First Name:SALLY
Middle Name:C
Last Name:SWANSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1726 EAGAN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-3702
Mailing Address - Country:US
Mailing Address - Phone:608-265-1221
Mailing Address - Fax:608-263-2666
Practice Address - Street 1:1726 EAGAN RD STE 100
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-3702
Practice Address - Country:US
Practice Address - Phone:608-265-1221
Practice Address - Fax:608-263-2666
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA093017225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT34583AMedicare PIN