Provider Demographics
NPI:1285991141
Name:SWIMMER, JODY GAIL (PT, DPT, MAT)
Entity type:Individual
Prefix:
First Name:JODY
Middle Name:GAIL
Last Name:SWIMMER
Suffix:
Gender:F
Credentials:PT, DPT, MAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 S HITE AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-2517
Mailing Address - Country:US
Mailing Address - Phone:502-599-2750
Mailing Address - Fax:
Practice Address - Street 1:218 S HITE AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-2517
Practice Address - Country:US
Practice Address - Phone:502-599-2750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-17
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY006009225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist