Provider Demographics
NPI:1467724898
Name:SWALE, JACQUELINE COLLIER (DPT)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:COLLIER
Last Name:SWALE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:872 TARTAN LOOP
Mailing Address - Street 2:
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33853-3582
Mailing Address - Country:US
Mailing Address - Phone:615-476-6567
Mailing Address - Fax:
Practice Address - Street 1:427 BURNS AVE
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33853-3314
Practice Address - Country:US
Practice Address - Phone:863-679-3338
Practice Address - Fax:205-939-6067
Is Sole Proprietor?:No
Enumeration Date:2012-02-01
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH6264225100000X
FLPT38994225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist