Provider Demographics
NPI:1699455766
Name:SWAIN, ANASTASIA CHARITY (LMT)
Entity type:Individual
Prefix:MS
First Name:ANASTASIA
Middle Name:CHARITY
Last Name:SWAIN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 BEAUMONT DR APT 202
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-1821
Mailing Address - Country:US
Mailing Address - Phone:163-085-1851
Mailing Address - Fax:
Practice Address - Street 1:807 BEAUMONT DR APT 202
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-1821
Practice Address - Country:US
Practice Address - Phone:163-085-1851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.012973225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist