Provider Demographics
NPI:1114125432
Name:SWIFT, MICHELLE GROESZ (PT)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:GROESZ
Last Name:SWIFT
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 1:1615 NE SARATOGA ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-4729
Mailing Address - Country:US
Mailing Address - Phone:503-516-7460
Mailing Address - Fax:
Practice Address - Street 1:15850 NW CENTRAL DR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-1101
Practice Address - Country:US
Practice Address - Phone:503-906-5770
Practice Address - Fax:503-906-5796
Is Sole Proprietor?:No
Enumeration Date:2007-07-08
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3657225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics