Provider Demographics
NPI:1659672137
Name:SWICK, JACKLYN ROBERTS (DPT)
Entity Type:Individual
Prefix:MRS
First Name:JACKLYN
Middle Name:ROBERTS
Last Name:SWICK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3108
Mailing Address - Country:US
Mailing Address - Phone:714-544-5565
Mailing Address - Fax:714-544-5570
Practice Address - Street 1:365 W 1ST ST
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3108
Practice Address - Country:US
Practice Address - Phone:714-544-5565
Practice Address - Fax:714-544-5570
Is Sole Proprietor?:No
Enumeration Date:2010-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT37322225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist