Provider Demographics
NPI:1417605874
Name:SWOBODA, MICHAEL (DHSC, CSCS, EP-C)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:SWOBODA
Suffix:
Gender:M
Credentials:DHSC, CSCS, EP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 W VAUGHN AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-4409
Mailing Address - Country:US
Mailing Address - Phone:330-502-6252
Mailing Address - Fax:
Practice Address - Street 1:92 W VAUGHN AVE
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-4409
Practice Address - Country:US
Practice Address - Phone:330-502-6252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ684330224Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Y00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersClinical Exercise Physiologist