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General NPI Number Information
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NPI Number | 1861043416
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Entity Type | Individual
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Provider Name | MARY ESTHER SWANSTROM ATC
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Gender | Female
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Dates
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Enumeration Date | 09/25/2019
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Last Update Date | 06/29/2022
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Provider Practice Location Address
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Address Line | 8380 EL MUNDO ST APT 415
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City | HOUSTON
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State | TX
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Zip | 77054-4627
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Country | US
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Telephone | 773-499-9449
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Fax |
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Provider Business Mailing Address
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Address Line | 8380 EL MUNDO ST APT 415
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City | HOUSTON
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State | TX
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Zip | 77054-4627
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Country | US
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Telephone | 773-499-9449
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 096.004577
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT8316
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License Number State | TX
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