Provider Demographics
NPI:1538309752
Name:SWANSON, ERIC ARTHUR (PT)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:ARTHUR
Last Name:SWANSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1698 W HIBISCUS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-2639
Mailing Address - Country:US
Mailing Address - Phone:321-768-6119
Mailing Address - Fax:321-768-1710
Practice Address - Street 1:1698 W HIBISCUS BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-2639
Practice Address - Country:US
Practice Address - Phone:321-768-6119
Practice Address - Fax:321-768-1710
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-27
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT16357225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist