MEDICARE: DR. NICHOLE LEI BOY SWANSON PT, ATC

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	6301	AZ
2	225100000X	Physical Therapist	7255	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265414981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICHOLE LEI BOY SWANSON PT, ATC

Provider Business Mailing Address
First Line	:	1295 WESTHAVEN DR
Second Line	:
City	:	VAIL
State	:	CO
Zip	:	81657-4395
Country	:	US
Telephone Number	:	970-476-7510
Fax Number	:

Provider Business Practice Location Address
First Line	:	1596 SUSAN A WILLIAMS WAY
Second Line	:	SUITE D
City	:	CHINO VALLEY
State	:	AZ
Zip	:	86323-6172
Country	:	US
Telephone Number	:	928-636-7950
Fax Number	:	928-636-7951

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

Provider Enumeration Date	:	11/17/2005
Last Update Date	:	01/30/2025

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