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General NPI Number Information
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NPI Number | 1467113530
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Entity Type | Individual
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Provider Name | MICAH SWANK PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 12/31/2021
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Last Update Date | 03/19/2024
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Provider Practice Location Address
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Address Line | 150 NEW CENTURY PKWY
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City | NEW CENTURY
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State | KS
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Zip | 66031-1150
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Country | US
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Telephone | 913-213-3023
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Fax |
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Provider Business Mailing Address
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Address Line | 29512 W 184TH ST
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City | GARDNER
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State | KS
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Zip | 66030-9583
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Country | US
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Telephone |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 11-06405
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License Number State | KS
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