Provider Demographics
NPI:1316083041
Name:SWANSON SCHAACK PHYSICAL THERAPY
Entity type:Organization
Organization Name:SWANSON SCHAACK PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ELLSWORTH
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:916-789-1111
Mailing Address - Street 1:801 STERLING PKWY
Mailing Address - Street 2:STE 150
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-7326
Mailing Address - Country:US
Mailing Address - Phone:916-543-7900
Mailing Address - Fax:916-543-7910
Practice Address - Street 1:801 STERLING PKWY
Practice Address - Street 2:STE 150
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648-7326
Practice Address - Country:US
Practice Address - Phone:916-543-7900
Practice Address - Fax:916-543-7910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty