Provider Demographics
NPI:1205815784
Name:SWANSON, RONALD PHILIP (MSPT)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:PHILIP
Last Name:SWANSON
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 POPLAR CHURCH RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-2203
Mailing Address - Country:US
Mailing Address - Phone:717-975-3200
Mailing Address - Fax:717-975-3204
Practice Address - Street 1:503 N 21ST ST
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-2204
Practice Address - Country:US
Practice Address - Phone:717-975-3200
Practice Address - Fax:717-975-3204
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20812225100000X
PAPT018509225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2116104OtherMAMSI FSS
MD620106-01OtherCAREFIRST MD FSS
MDK134-0003OtherCAP FED BC MSS
MD334552OtherPHCS
MD147719000OtherDEPT OF LABOR FSS
MD602030700OtherDEPT OF LABOR MSS
MDR5590006OtherCAP FED BC FSS
MD3116104Other3116104
MD620106-02OtherCAREFIRST MSS
MDP99901Medicare UPIN
MDP00205429Medicare ID - Type UnspecifiedMC RAILROAD
MD3116104Other3116104
MD123MH085Medicare ID - Type UnspecifiedMEDICARE FSS