Provider Demographics
NPI:1629375399
Name:SWANSON, AARON LOUIS (PT)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:LOUIS
Last Name:SWANSON
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 1:10 STUYVESANT OVAL
Mailing Address - Street 2:APT. #5E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-2420
Mailing Address - Country:US
Mailing Address - Phone:865-414-0572
Mailing Address - Fax:
Practice Address - Street 1:100 MANHATTAN AVE
Practice Address - Street 2:SUITE 714
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-5240
Practice Address - Country:US
Practice Address - Phone:877-644-8090
Practice Address - Fax:646-839-2598
Is Sole Proprietor?:No
Enumeration Date:2011-02-16
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033236-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist