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General NPI Number Information
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NPI Number | 1750538336
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Entity Type | Organization
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Legal Business Name | SWELL ENDEAVORS PHYSICAL THERAPY, INC
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Dates
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Enumeration Date | 08/26/2008
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Last Update Date | 08/04/2021
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Provider Practice Location Address
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Address Line | 2770 EUREKA WAY STE 100
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City | REDDING
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State | CA
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Zip | 96001-0252
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Country | US
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Telephone | 530-241-1900
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Fax | 530-241-2489
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Provider Business Mailing Address
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Address Line | 2770 EUREKA WAY STE 100
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City | REDDING
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State | CA
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Zip | 96001-0252
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Country | US
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Telephone | 530-241-1900
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Fax | 530-241-2489
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARK DANIEL VAN LOAN
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Credential | MPT
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Telephone | 530-241-1900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT26561
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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