Provider Demographics
NPI:1023536513
Name:SWENSON, PT, MICHAEL T (DPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:T
Last Name:SWENSON, PT
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:MIKE
Other - Middle Name:
Other - Last Name:SWENSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 142
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-0142
Mailing Address - Country:US
Mailing Address - Phone:210-660-5235
Mailing Address - Fax:833-673-0220
Practice Address - Street 1:8425 BANDERA RD STE 120
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78250-2519
Practice Address - Country:US
Practice Address - Phone:210-660-5235
Practice Address - Fax:833-673-0220
Is Sole Proprietor?:No
Enumeration Date:2017-09-05
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1294213225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1023536513Medicaid