Provider Demographics
NPI:1578850343
Name:SWAIN, JASON LEE
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:LEE
Last Name:SWAIN
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 1:1900 WESLEYAN DR
Mailing Address - Street 2:APT 101
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-8807
Mailing Address - Country:US
Mailing Address - Phone:662-312-6911
Mailing Address - Fax:
Practice Address - Street 1:101 STILLWATER CIR
Practice Address - Street 2:
Practice Address - City:BONAIRE
Practice Address - State:GA
Practice Address - Zip Code:31005-3857
Practice Address - Country:US
Practice Address - Phone:478-293-1680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-30
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT010295225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist