Provider Demographics
NPI:1568561504
Name:SWINGER, MICHAEL GALEN (PT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:GALEN
Last Name:SWINGER
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 1:65 S MAIN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-1286
Mailing Address - Country:US
Mailing Address - Phone:616-866-8084
Mailing Address - Fax:616-866-8085
Practice Address - Street 1:65 S MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-1286
Practice Address - Country:US
Practice Address - Phone:616-866-8084
Practice Address - Fax:616-866-8085
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012562225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist