Provider Demographics
NPI:1558581561
Name:SWOVERLAND, KRISTIE L (PT)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:L
Last Name:SWOVERLAND
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10911 OLD OAK CT
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-9480
Mailing Address - Country:US
Mailing Address - Phone:260-338-1241
Mailing Address - Fax:
Practice Address - Street 1:10911 OLD OAK CT
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-9480
Practice Address - Country:US
Practice Address - Phone:260-338-1241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05003196A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist