Provider Demographics
NPI:1285069963
Name:SWIFT, ANTHONY CLIFFORD
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:CLIFFORD
Last Name:SWIFT
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:ANTHONY
Other - Middle Name:CLIFFORD
Other - Last Name:SWIFT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:14504 BLACKSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:DOLTON
Mailing Address - State:IL
Mailing Address - Zip Code:60419-2438
Mailing Address - Country:US
Mailing Address - Phone:708-519-0403
Mailing Address - Fax:
Practice Address - Street 1:2649 E 75TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-3835
Practice Address - Country:US
Practice Address - Phone:773-356-9300
Practice Address - Fax:773-721-5842
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160006516225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant