Provider Demographics
NPI:1407106552
Name:SWARTZ, FREDERICK EDWARD (PT)
Entity Type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:EDWARD
Last Name:SWARTZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:FRED
Other - Middle Name:
Other - Last Name:SWARTZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPT
Mailing Address - Street 1:5980 80TH ST N UNIT 104
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709
Mailing Address - Country:US
Mailing Address - Phone:727-867-7143
Mailing Address - Fax:
Practice Address - Street 1:5980 80TH ST N UNIT 104
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-1003
Practice Address - Country:US
Practice Address - Phone:727-867-7143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT20602174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist