Basic Information
| Provider Information | |||||||||
| NPI: | 1740213768 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SWIDER | ||||||||
| FirstName: | DEBORAH | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | PT | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | WOLD | ||||||||
| OtherFirstName: | DEBORAH | ||||||||
| OtherMiddleName: | E | ||||||||
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| OtherCredential: | PT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 940 W IRONWOOD DR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | COEUR D ALENE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838142486 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2086648194 | ||||||||
| FaxNumber: | 2086671847 | ||||||||
| Practice Location | |||||||||
| Address1: | 750 N SYRINGA ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | POST FALLS | ||||||||
| State: | ID | ||||||||
| PostalCode: | 838545275 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2087738111 | ||||||||
| FaxNumber: | 2087738385 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT-2063 | ID | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT-5843 | NC | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.