Provider Demographics
NPI:1477952406
Name:SWIEBODA, STELLA K (DPT)
Entity Type:Individual
Prefix:
First Name:STELLA
Middle Name:K
Last Name:SWIEBODA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:STELLA
Other - Middle Name:K
Other - Last Name:MEYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 441146
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30160-9522
Mailing Address - Country:US
Mailing Address - Phone:678-459-3745
Mailing Address - Fax:
Practice Address - Street 1:3135 PEOPLES ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-4130
Practice Address - Country:US
Practice Address - Phone:423-454-1006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP15716225100000X
GAPT011584225100000X
TN11108225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I657682Medicare PIN