Provider Demographics
NPI:1720578610
Name:SWANSON, JANE CAMPBELL (DPT)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:CAMPBELL
Last Name:SWANSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:JANE
Other - Middle Name:ANN
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:868 S 1400 E
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84105-1637
Mailing Address - Country:US
Mailing Address - Phone:801-510-9766
Mailing Address - Fax:
Practice Address - Street 1:280 N MAIN ST # 2
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-6136
Practice Address - Country:US
Practice Address - Phone:801-397-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-55642251P0200X
UT2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics