Provider Demographics
NPI:1245788025
Name:SWAMINATHAN, SRIVANI DORESWAMY (PT, MS, DPT)
Entity Type:Individual
Prefix:
First Name:SRIVANI
Middle Name:DORESWAMY
Last Name:SWAMINATHAN
Suffix:
Gender:F
Credentials:PT, MS, DPT
Other - Prefix:
Other - First Name:SRIVANI
Other - Middle Name:
Other - Last Name:DORESWAMY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, MS
Mailing Address - Street 1:1000 N WESTMORELAND RD FL 2
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-1658
Mailing Address - Country:US
Mailing Address - Phone:224-271-6519
Mailing Address - Fax:847-535-7259
Practice Address - Street 1:1000 N WESTMORELAND RD
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1658
Practice Address - Country:US
Practice Address - Phone:224-271-6519
Practice Address - Fax:847-535-7259
Is Sole Proprietor?:No
Enumeration Date:2016-09-21
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT27144225100000X
IL070021949225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist