Provider Demographics
NPI:1275315673
Name:SWING, KELLI V (MED, ATC, LAT, CES)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:V
Last Name:SWING
Suffix:
Gender:F
Credentials:MED, ATC, LAT, CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3005 BINKLEY AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-2353
Mailing Address - Country:US
Mailing Address - Phone:214-768-2312
Mailing Address - Fax:214-768-1968
Practice Address - Street 1:3005 BINKLEY AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-2353
Practice Address - Country:US
Practice Address - Phone:214-768-2312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT32642255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer