Provider Demographics
NPI:1144794371
Name:SWANSON, JANET MARY (PTA)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:MARY
Last Name:SWANSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12626 BLANCO RD APT 804
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-8256
Mailing Address - Country:US
Mailing Address - Phone:210-585-0719
Mailing Address - Fax:
Practice Address - Street 1:8501 LAURENS LN
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78218-6092
Practice Address - Country:US
Practice Address - Phone:210-804-1223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-22
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2023000225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant