Provider Demographics
NPI:1285999219
Name:SWEARINGEN PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:SWEARINGEN PHYSICAL THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FONTAINE
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:SWEARINGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-466-3199
Mailing Address - Street 1:29 DOMINGO RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-8256
Mailing Address - Country:US
Mailing Address - Phone:505-466-3199
Mailing Address - Fax:
Practice Address - Street 1:29 DOMINGO RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87508-8256
Practice Address - Country:US
Practice Address - Phone:505-466-3199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-05
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1162225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty