Healthcare Provider Details

I. General information

NPI: 1932250255
Provider Name (Legal Business Name): REBECCA NELSON SWICK DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 04/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 7TH AVE S
ST PETERSBURG FL
33701-4820
US

IV. Provider business mailing address

500 7TH AVE S
ST. PETERSBURG FL
33701-6106
US

V. Phone/Fax

Practice location:
  • Phone: 727-767-8065
  • Fax:
Mailing address:
  • Phone: 727-767-8065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT008402
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT24601
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: