Provider Demographics
NPI:1467113530
Name:SWANK, MICAH (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:MICAH
Middle Name:
Last Name:SWANK
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29512 W 184TH ST
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:KS
Mailing Address - Zip Code:66030-9583
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:150 NEW CENTURY PKWY
Practice Address - Street 2:
Practice Address - City:NEW CENTURY
Practice Address - State:KS
Practice Address - Zip Code:66031-1150
Practice Address - Country:US
Practice Address - Phone:913-213-3023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-31
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-06405225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist