Provider Demographics
NPI:1497016109
Name:SWAIN, TAYLOR O'NEAL (PTA)
Entity Type:Individual
Prefix:MS
First Name:TAYLOR
Middle Name:O'NEAL
Last Name:SWAIN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 EAST MOORE AVENUE
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-8654
Mailing Address - Country:US
Mailing Address - Phone:501-268-5001
Mailing Address - Fax:501-268-5443
Practice Address - Street 1:2501 E MOORE AVE
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4751
Practice Address - Country:US
Practice Address - Phone:501-268-5001
Practice Address - Fax:501-268-5443
Is Sole Proprietor?:No
Enumeration Date:2012-05-30
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2632225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant