Provider Demographics
NPI:1386914299
Name:SWANSON, SCOTT (PT)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:SWANSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7098 FELTON RD
Mailing Address - Street 2:
Mailing Address - City:MAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14757-9739
Mailing Address - Country:US
Mailing Address - Phone:716-753-0403
Mailing Address - Fax:
Practice Address - Street 1:7098 FELTON RD
Practice Address - Street 2:
Practice Address - City:MAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:14757-9739
Practice Address - Country:US
Practice Address - Phone:703-536-4344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305207227225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist