1114973435 NPI number — MRS. STEPHANIE D SWANSON MPT

Table of content: MRS. STEPHANIE D SWANSON MPT (NPI 1114973435)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114973435 NPI number — MRS. STEPHANIE D SWANSON MPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SWANSON
Provider First Name:
STEPHANIE
Provider Middle Name:
D
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SWANSON
Provider Other First Name:
STEPHANIE
Provider Other Middle Name:
D
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MPT
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1114973435
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1012 WOODLAND LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAINESPORT
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08036-3720
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-518-7966
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1401 ROUTE 70 W
Provider Second Line Business Practice Location Address:
FOX REHABILITATION SERVICES
Provider Business Practice Location Address City Name:
CHERRY HILL
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08002-3731
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-407-3422
Provider Business Practice Location Address Fax Number:
877-407-4329
Provider Enumeration Date:
05/26/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  40QA00905700 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)