Provider Demographics
NPI:1093829897
Name:SWAIN, ADAM T (PT OCS ATC)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:T
Last Name:SWAIN
Suffix:
Gender:M
Credentials:PT OCS ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5886 VENTURE PARK
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-1848
Mailing Address - Country:US
Mailing Address - Phone:269-375-4737
Mailing Address - Fax:269-375-2266
Practice Address - Street 1:5886 VENTURE PARK
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-1848
Practice Address - Country:US
Practice Address - Phone:269-375-4737
Practice Address - Fax:269-375-2266
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501005172225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6430152OtherIBA
MI7613708OtherAETNA
MIP22340001Medicare ID - Type Unspecified