Healthcare Provider Details

I. General information

NPI: 1801017520
Provider Name (Legal Business Name): ADRIANNE L SWINNEY ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 04/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3837 SIMPSON STUART RD
DALLAS TX
75241-4331
US

IV. Provider business mailing address

PO BOX 3095
DESOTO TX
75123-3095
US

V. Phone/Fax

Practice location:
  • Phone: 214-876-5991
  • Fax:
Mailing address:
  • Phone: 214-876-5991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT3086
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: