Provider Demographics
NPI:1588871446
Name:SWART, PAUL (PT)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:
Last Name:SWART
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 1:2615 CENTENNIAL BLVD STE 101
Mailing Address - Street 2:SUITE 101
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-0589
Mailing Address - Country:US
Mailing Address - Phone:850-656-1837
Mailing Address - Fax:
Practice Address - Street 1:2615 CENTENNIAL BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-0586
Practice Address - Country:US
Practice Address - Phone:850-656-1837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT252242251X0800X
INPT252242251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic