Provider Demographics
NPI:1114330628
Name:SWARTOUT, ANDREW (DPT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:SWARTOUT
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1180 N MAIN ST
Mailing Address - Street 2:SUITE 1 & 2
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-1388
Mailing Address - Country:US
Mailing Address - Phone:419-291-8643
Mailing Address - Fax:
Practice Address - Street 1:1180 N MAIN ST
Practice Address - Street 2:SUITE 1 & 2
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-1388
Practice Address - Country:US
Practice Address - Phone:419-291-8643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501016798225100000X
OHPT.015154225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist