Provider Demographics
NPI:1114973435
Name:SWANSON, STEPHANIE D (MPT)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:D
Last Name:SWANSON
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MRS
Other - First Name:STEPHANIE
Other - Middle Name:D
Other - Last Name:SWANSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MPT
Mailing Address - Street 1:1012 WOODLAND LN
Mailing Address - Street 2:
Mailing Address - City:HAINESPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:08036-3720
Mailing Address - Country:US
Mailing Address - Phone:609-518-7966
Mailing Address - Fax:
Practice Address - Street 1:1401 ROUTE 70 W
Practice Address - Street 2:FOX REHABILITATION SERVICES
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-3731
Practice Address - Country:US
Practice Address - Phone:877-407-3422
Practice Address - Fax:877-407-4329
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00905700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist