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General NPI Number Information
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NPI Number | 1528694270
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Entity Type | Individual
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Provider Name | JEREMY JOSEPH SWANSON
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Gender | Male
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Dates
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Enumeration Date | 03/13/2020
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Last Update Date | 03/13/2020
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Provider Practice Location Address
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Address Line | 501 SE FLOWER MOUND RD
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City | LAWTON
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State | OK
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Zip | 73501-6388
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Country | US
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Telephone | 580-351-6511
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Fax |
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Provider Business Mailing Address
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Address Line | 2205 MEADOW LARK DR
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City | DUNCAN
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State | OK
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Zip | 73533-1313
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Country | US
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Telephone | 580-678-8436
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number |
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License Number State |
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