Healthcare Provider Details

I. General information

NPI: 1932413382
Provider Name (Legal Business Name): MICAH J SWIFT PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2010
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1516 S COMMERCIAL ST
NEENAH WI
54956-4802
US

IV. Provider business mailing address

3 NEENAH CTR
NEENAH WI
54956-3070
US

V. Phone/Fax

Practice location:
  • Phone: 920-831-5050
  • Fax: 920-735-7648
Mailing address:
  • Phone: 920-831-5050
  • Fax: 920-735-7648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11516-024
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: