Basic Information
| Provider Information | |||||||||
| NPI: | 1548808496 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SWIENTON | ||||||||
| FirstName: | MICHAEL | ||||||||
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| Credential: | PT, DPT, CSCS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2900 CHARLEVOIX DR SE STE 200 | ||||||||
| Address2: | |||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495467086 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006341077 | ||||||||
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| Practice Location | |||||||||
| Address1: | 270 INTERNATIONAL CIR | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951191100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4089723000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2019 | ||||||||
| LastUpdateDate: | 12/11/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/11/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 045101 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.