Provider Demographics
NPI:1679889976
Name:SWEANY, MARY K (PT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:K
Last Name:SWEANY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4131 W LOOMIS RD STE 200
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53221-2041
Mailing Address - Country:US
Mailing Address - Phone:414-281-5151
Mailing Address - Fax:414-281-5987
Practice Address - Street 1:4131 W LOOMIS RD
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53221-2057
Practice Address - Country:US
Practice Address - Phone:414-281-5151
Practice Address - Fax:414-281-5987
Is Sole Proprietor?:No
Enumeration Date:2010-08-24
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11603-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist