Healthcare Provider Details

I. General information

NPI: 1316718786
Provider Name (Legal Business Name): SWAN THERAPY GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2024
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19342 N MARICOPA RD STE 100
MARICOPA AZ
85139-2856
US

IV. Provider business mailing address

8777 E VIA DE VENTURA STE 315
SCOTTSDALE AZ
85258-3371
US

V. Phone/Fax

Practice location:
  • Phone: 480-687-8512
  • Fax: 602-878-9713
Mailing address:
  • Phone: 480-687-8512
  • Fax: 602-878-9713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: PAMELA MILLER
Title or Position: COO
Credential:
Phone: 480-687-8512