Provider Demographics
NPI:1558041996
Name:SWOPE, KELVIN ALLEN (ATC)
Entity Type:Individual
Prefix:
First Name:KELVIN
Middle Name:ALLEN
Last Name:SWOPE
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3235 BOB DR APT B
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-8683
Mailing Address - Country:US
Mailing Address - Phone:520-732-8876
Mailing Address - Fax:
Practice Address - Street 1:3700 WILLOW CREEK RD BLDG 80
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-3720
Practice Address - Country:US
Practice Address - Phone:520-732-8876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZATR-0095602255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer