Basic Information
| Provider Information | |||||||||
| NPI: | 1184239725 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SWIEBODA | ||||||||
| FirstName: | KEVIN | ||||||||
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| Credential: | PT, DPT, OCS, CSCS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 34 SUMMER MEADOW RD | ||||||||
| Address2: | |||||||||
| City: | ARDEN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287047601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6302549702 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1322 E WASHINGTON ST STE B1 | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296071867 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8647294081 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2020 | ||||||||
| LastUpdateDate: | 09/10/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 10407 | SC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.