Provider Demographics
NPI:1619094885
Name:SWINGLE, POLLY A (PT)
Entity Type:Individual
Prefix:MRS
First Name:POLLY
Middle Name:A
Last Name:SWINGLE
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 1:20000 VICTOR PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-7029
Mailing Address - Country:US
Mailing Address - Phone:734-953-1745
Mailing Address - Fax:734-953-1743
Practice Address - Street 1:20000 VICTOR PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-7029
Practice Address - Country:US
Practice Address - Phone:734-953-1745
Practice Address - Fax:734-953-1743
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501007125225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI22348OtherBCBS PROVIDER NUMBER
MIN95990001Medicare ID - Type Unspecified