Provider Demographics
NPI:1386903581
Name:SWAIN, JAMES HENRY (MPT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:HENRY
Last Name:SWAIN
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11746 W FLAMINGO AVE
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-8254
Mailing Address - Country:US
Mailing Address - Phone:208-467-5993
Mailing Address - Fax:
Practice Address - Street 1:11746 W FLAMINGO AVE
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-8254
Practice Address - Country:US
Practice Address - Phone:208-467-5993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-08
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-441225100000X
WAPT-900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist