Provider Demographics
NPI:1033385620
Name:SWANNIE, ERIC EDWIN (ATC, LAT, CSCS)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:EDWIN
Last Name:SWANNIE
Suffix:
Gender:M
Credentials:ATC, LAT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 2ND PL
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-3056
Mailing Address - Country:US
Mailing Address - Phone:407-831-8185
Mailing Address - Fax:
Practice Address - Street 1:655 LONGWOOD LAKE MARY RD
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3701
Practice Address - Country:US
Practice Address - Phone:407-320-9753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 3752255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer