Provider Demographics
NPI:1134278757
Name:SWIFT, MATT (PT)
Entity Type:Individual
Prefix:
First Name:MATT
Middle Name:
Last Name:SWIFT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7076 EDINGER AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-3503
Mailing Address - Country:US
Mailing Address - Phone:714-263-6388
Mailing Address - Fax:714-362-3147
Practice Address - Street 1:1500 S ANAHEIM BLVD
Practice Address - Street 2:STE 130
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-6242
Practice Address - Country:US
Practice Address - Phone:714-917-3558
Practice Address - Fax:714-917-3560
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT#33345225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT#33345OtherPT LICENSE