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General NPI Number Information
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NPI Number | 1861041345
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Entity Type | Individual
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Provider Name | WILLIAM BRUCE SWAIN
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Gender | Male
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Dates
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Enumeration Date | 09/08/2019
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Last Update Date | 09/08/2019
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Provider Practice Location Address
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Address Line | 4800 CLINTONVILLE RD
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City | CLARKSTON
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State | MI
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Zip | 48346-4297
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Country | US
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Telephone | 248-674-0309
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Fax |
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Provider Business Mailing Address
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Address Line | 188 PENINSULA LAKE DR
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City | HIGHLAND
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State | MI
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Zip | 48357-2851
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Country | US
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Telephone | 248-505-4289
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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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