Provider Demographics
NPI:1003040049
Name:SWANNER, NICHOLAS B (MPT, GCS)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:B
Last Name:SWANNER
Suffix:
Gender:M
Credentials:MPT, GCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 APPLEWOOD DR
Mailing Address - Street 2:BROOKDALE THERAPY
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-1395
Mailing Address - Country:US
Mailing Address - Phone:404-971-8544
Mailing Address - Fax:414-918-6046
Practice Address - Street 1:1000 APPLEWOOD DR
Practice Address - Street 2:BROOKDALE THERAPY
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-1395
Practice Address - Country:US
Practice Address - Phone:404-971-8544
Practice Address - Fax:414-918-6046
Is Sole Proprietor?:No
Enumeration Date:2009-05-05
Last Update Date:2019-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA008351225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist