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General NPI Number Information
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NPI Number | 1295181659
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Entity Type | Individual
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Provider Name | JAN SWISCZ
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Gender | Female
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Dates
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Enumeration Date | 05/04/2016
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Last Update Date | 05/04/2016
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Provider Practice Location Address
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Address Line | 1104 21ST. STRE REEDSBURG AREA MEDICAL SPECIALTY CENTER
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City | REEDSBURG
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State | WI
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Zip | 53959
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Country | US
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Telephone | 847-815-3094
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Fax |
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Provider Business Mailing Address
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Address Line | S1265B SUMMIT POINT DR
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City | LA VALLE
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State | WI
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Zip | 53941-9526
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Country | US
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Telephone | 847-815-3094
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 10823-146
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License Number State | WI
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