MEDICARE: SEASON SWIFT P.T.

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	3934	OK

General Provider Information

NPI Number	:	1679841845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEASON SWIFT P.T.

Provider Business Mailing Address
First Line	:	11904 GWENDOLYN LN
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73131-4403
Country	:	US
Telephone Number	:	405-249-4674
Fax Number	:	405-286-5039

Provider Business Practice Location Address
First Line	:	11904 GWENDOLYN LN
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73131-4403
Country	:	US
Telephone Number	:	405-249-4674
Fax Number	:	405-286-5039

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

Provider Enumeration Date	:	12/02/2011
Last Update Date	:	11/01/2012

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Directions to “ SEASON SWIFT P.T.” Practice Location

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