Basic Information
| Provider Information | |||||||||
| NPI: | 1902298623 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SWANSON | ||||||||
| FirstName: | STEVEN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5006 CENTER ST STE N | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984092314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534760449 | ||||||||
| FaxNumber: | 2534760286 | ||||||||
| Practice Location | |||||||||
| Address1: | 702 S HILL PARK DR STE 101 | ||||||||
| Address2: | |||||||||
| City: | PUYALLUP | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983731426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2536044953 | ||||||||
| FaxNumber: | 2536044956 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/04/2015 | ||||||||
| LastUpdateDate: | 03/04/2015 | ||||||||
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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 | PT60529872 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.