Basic Information
| Provider Information | |||||||||
| NPI: | 1447299276 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SWALLOW | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 W 10TH ST | ||||||||
| Address2: | |||||||||
| City: | MARCUS HOOK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190614513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108598850 | ||||||||
| FaxNumber: | 6108597876 | ||||||||
| Practice Location | |||||||||
| Address1: | 1999 SPROUL RD | ||||||||
| Address2: | SUITE 10 | ||||||||
| City: | BROOMALL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190083508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103591134 | ||||||||
| FaxNumber: | 6103532109 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2006 | ||||||||
| LastUpdateDate: | 07/25/2012 | ||||||||
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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 | PTO13144L | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 036472VLZ | 01 | MEDICARE | OTHER | P0069287 | 01 | PA | MEDICARE RR | OTHER | 306223 | 01 | UNISON | OTHER | 0709313000 | 01 | PA | BLUE CROSS | OTHER | 102313787 | 05 | PA | MEDICAID | 102313787-0001 | 05 | PA | MEDICAID | 30065490 | 01 | PA | KEYSTONE MERCY | OTHER | P00692887 | 01 | MEDICARE RR | OTHER | 0709313000 | 01 | PA | IBC | OTHER | 1447299276 | 01 | BRAVO | OTHER | 550423 | 01 | HIGHMARK PABS | OTHER |