1477561470 NPI number — MR. PAUL ELLSWORTH SWANSON PT

Table of content: MR. PAUL ELLSWORTH SWANSON PT (NPI 1477561470)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477561470 NPI number — MR. PAUL ELLSWORTH SWANSON PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SWANSON
Provider First Name:
PAUL
Provider Middle Name:
ELLSWORTH
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477561470
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:
2103 PYRAMID CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKLIN
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95765
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:
916-956-9630

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2295 FIELDSTONE DR
Provider Second Line Business Practice Location Address:
STE 210
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95648
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-543-7900
Provider Business Practice Location Address Fax Number:
916-543-7910
Provider Enumeration Date:
08/04/2006

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:  PT10291 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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