Healthcare Provider Details

I. General information

NPI: 1073802831
Provider Name (Legal Business Name): MARIE SWANSON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2011
Last Update Date: 09/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 N DALE MABRY HWY
TAMPA FL
33609-1251
US

IV. Provider business mailing address

909 N DALE MABRY HWY
TAMPA FL
33609-1251
US

V. Phone/Fax

Practice location:
  • Phone: 813-978-9700
  • Fax: 813-558-6187
Mailing address:
  • Phone: 813-978-9700
  • Fax: 813-558-6187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1087294
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT30681
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: