Provider Demographics
NPI:1558726554
Name:SWINCHOSKI, TIMOTHY JOSEPH
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:JOSEPH
Last Name:SWINCHOSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 N 18TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64505-2140
Mailing Address - Country:US
Mailing Address - Phone:816-262-5419
Mailing Address - Fax:913-492-4741
Practice Address - Street 1:15301 W 87TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66219-1401
Practice Address - Country:US
Practice Address - Phone:913-492-4888
Practice Address - Fax:913-492-4741
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-18
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-1123225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant