Healthcare Provider Details

I. General information

NPI: 1962096123
Provider Name (Legal Business Name): SWORD HEALTH CARE PHYSICAL THERAPY PROVIDERS OF CA, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2021
Last Update Date: 02/02/2026
Certification Date: 02/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 BROADWAY STE 1109
NEW YORK NY
10010-7192
US

IV. Provider business mailing address

169 MADISON AVE STE 15501
NEW YORK NY
10016-5101
US

V. Phone/Fax

Practice location:
  • Phone: 801-915-2702
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name: JENNESA ATHERTON
Title or Position: PRESIDENT
Credential: DPT
Phone: 815-238-8577