Basic Information
| Provider Information | |||||||||
| NPI: | 1023339991 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SWEARINGEN | ||||||||
| FirstName: | CARL | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | PHYSICAL THERAPIST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8 HOSPITAL CENTER BLVD | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | HILTON HEAD ISLAND | ||||||||
| State: | SC | ||||||||
| PostalCode: | 299268700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436717342 | ||||||||
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| Practice Location | |||||||||
| Address1: | 15 MOSS CREEK VLG | ||||||||
| Address2: | |||||||||
| City: | HILTON HEAD ISLAND | ||||||||
| State: | SC | ||||||||
| PostalCode: | 299261105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8438367003 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2010 | ||||||||
| LastUpdateDate: | 06/08/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT 002841 | WV | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 7824 | SC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 3810017872 | 05 | WV | MEDICAID |