Provider Demographics
NPI:1659819209
Name:SWINFORD, ATHENA DIANE (LMT)
Entity Type:Individual
Prefix:
First Name:ATHENA
Middle Name:DIANE
Last Name:SWINFORD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4325 LAUREL ST STE 265
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5370
Mailing Address - Country:US
Mailing Address - Phone:907-602-7273
Mailing Address - Fax:907-562-0780
Practice Address - Street 1:4325 LAUREL ST STE 265
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5370
Practice Address - Country:US
Practice Address - Phone:907-602-7273
Practice Address - Fax:907-562-0780
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-03
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist