Provider Demographics
NPI:1992891832
Name:SWAIN, SHANLI (DPT)
Entity type:Individual
Prefix:
First Name:SHANLI
Middle Name:
Last Name:SWAIN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 SE DELAWARE AVE
Mailing Address - Street 2:SUITE M
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50021-4011
Mailing Address - Country:US
Mailing Address - Phone:515-963-8723
Mailing Address - Fax:515-963-8755
Practice Address - Street 1:1555 SE DELAWARE AVE
Practice Address - Street 2:SUITE M
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50021-4011
Practice Address - Country:US
Practice Address - Phone:515-963-8723
Practice Address - Fax:515-963-8755
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3758225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0665430Medicaid
IAI19172015Medicare PIN
IAI19172Medicare PIN