Provider Demographics
NPI:1588177901
Name:SWAFFORD, MICHAELA (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:SWAFFORD
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6079 CONESTOGA TRL
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-9051
Mailing Address - Country:US
Mailing Address - Phone:812-343-3154
Mailing Address - Fax:
Practice Address - Street 1:230 S MARR RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-7267
Practice Address - Country:US
Practice Address - Phone:812-343-3154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-07
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36002794A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer