Healthcare Provider Details

I. General information

NPI: 1528305877
Provider Name (Legal Business Name): AMANDA LEE SWART DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2013
Last Update Date: 01/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 N KLEIN CIR
DERBY KS
67037-7011
US

IV. Provider business mailing address

731 N KLEIN CIR
DERBY KS
67037-7011
US

V. Phone/Fax

Practice location:
  • Phone: 316-440-9617
  • Fax: 316-440-9619
Mailing address:
  • Phone: 316-440-9617
  • Fax: 316-440-9619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11-03869
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: