Healthcare Provider Details

I. General information

NPI: 1891085601
Provider Name (Legal Business Name): CHAD SWANK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2011
Last Update Date: 04/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 N WASHINGTON AVE SUITE 4000
DALLAS TX
75246-1713
US

IV. Provider business mailing address

9944 FAIRCREST DR
DALLAS TX
75238-1544
US

V. Phone/Fax

Practice location:
  • Phone: 214-820-9393
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number1144582
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: