=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023652757
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIE T SWARTZ PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/06/2019
-----------------------------------------------------
Last Update Date | 11/06/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11974 EDGEHILL TERRACE RD
-----------------------------------------------------
City | PRINCESS ANNE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21853-2105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-651-0011
-----------------------------------------------------
Fax | 410-621-8023
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 RIVERSIDE DR UNIT 120
-----------------------------------------------------
City | POCOMOKE CITY
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21851-1064
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-274-9821
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 18432
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------