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General NPI Number Information
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NPI Number | 1376024885
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Entity Type | Individual
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Provider Name | DENISE DIANE SWANSON
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Gender | Female
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Dates
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Enumeration Date | 08/22/2018
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Last Update Date | 08/22/2018
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Provider Practice Location Address
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Address Line | 7712 SNIDER RD
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City | GILMER
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State | TX
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Zip | 75645-3915
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Country | US
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Telephone | 903-734-1194
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Fax |
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Provider Business Mailing Address
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Address Line | 7712 SNIDER RD
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City | GILMER
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State | TX
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Zip | 75645-3915
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Country | US
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Telephone | 903-452-8508
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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 | 2251G0304X
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Taxonomy Name | Geriatric Physical Therapist
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License Number | 2012175
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License Number State | TX
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