Provider Demographics
NPI:1619377678
Name:SWANTON, ROBERTA (ATC)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:
Last Name:SWANTON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3710 170TH ST
Mailing Address - Street 2:
Mailing Address - City:GOOSE LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:52750-9643
Mailing Address - Country:US
Mailing Address - Phone:563-219-1233
Mailing Address - Fax:
Practice Address - Street 1:3710 170TH ST
Practice Address - Street 2:
Practice Address - City:GOOSE LAKE
Practice Address - State:IA
Practice Address - Zip Code:52750-9643
Practice Address - Country:US
Practice Address - Phone:563-219-1233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer