MEDICARE: SAMUEL SWARTZ DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT36587	FL

General Provider Information

NPI Number	:	1154909067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL SWARTZ DPT

Provider Business Mailing Address
First Line	:	5889 RIVER WAY
Second Line	:
City	:	GLEN SAINT MARY
State	:	FL
Zip	:	32040-3323
Country	:	US
Telephone Number	:	904-477-3087
Fax Number	:

Provider Business Practice Location Address
First Line	:	5889 RIVER WAY
Second Line	:
City	:	GLEN SAINT MARY
State	:	FL
Zip	:	32040-3323
Country	:	US
Telephone Number	:	904-477-3087
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2021
Last Update Date	:	03/31/2021

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