Provider Demographics
NPI:1073753844
Name:KENIA, SWATI MULCHAND (PT)
Entity Type:Individual
Prefix:
First Name:SWATI
Middle Name:MULCHAND
Last Name:KENIA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 SAN SIMON ST
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-8006
Mailing Address - Country:US
Mailing Address - Phone:949-300-5790
Mailing Address - Fax:949-727-2193
Practice Address - Street 1:22 ODYSSEY
Practice Address - Street 2:STE 165
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3194
Practice Address - Country:US
Practice Address - Phone:949-727-2192
Practice Address - Fax:949-727-2193
Is Sole Proprietor?:No
Enumeration Date:2009-03-05
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35302225100000X
MI5501013577225100000X
CAPT35302225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist