Healthcare Provider Details

I. General information

NPI: 1922439983
Provider Name (Legal Business Name): BRYAN SWINT CPO/L, M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2013
Last Update Date: 07/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2809 N HURSTBOURNE PKWY 111
LOUISVILLE KY
40223-1283
US

IV. Provider business mailing address

2809 N HURSTBOURNE PKWY 111
LOUISVILLE KY
40223-1283
US

V. Phone/Fax

Practice location:
  • Phone: 502-882-9300
  • Fax: 502-882-8375
Mailing address:
  • Phone: 502-882-9300
  • Fax: 502-882-8375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberLO-285
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberLPO-308
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: