Provider Demographics
NPI:1649416645
Name:SWIDERSKI, JULIE LYNN (PT)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:LYNN
Last Name:SWIDERSKI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:JULIE
Other - Middle Name:LYNN
Other - Last Name:TOTARO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:34 FOXSHIRE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14606
Mailing Address - Country:US
Mailing Address - Phone:585-230-1488
Mailing Address - Fax:
Practice Address - Street 1:3255 BRIGHTON HENRIETTA TOWNLINE ROAD
Practice Address - Street 2:SUITE 102
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623
Practice Address - Country:US
Practice Address - Phone:585-427-2977
Practice Address - Fax:585-427-7410
Is Sole Proprietor?:No
Enumeration Date:2008-12-21
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021699-12251P0200X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics