Provider Demographics
NPI:1346792389
Name:SWAGER, LORI S (ATC)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:S
Last Name:SWAGER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 PEABODY ST
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-8812
Mailing Address - Country:US
Mailing Address - Phone:303-550-7562
Mailing Address - Fax:
Practice Address - Street 1:1189 S PERRY ST
Practice Address - Street 2:SUITE 150
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-1959
Practice Address - Country:US
Practice Address - Phone:303-688-8855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAT00008812255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer