Provider Demographics
NPI:1790020931
Name:SWAN, HEATHER JANETTE (LPTA)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:JANETTE
Last Name:SWAN
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5078 TOWNE CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2741
Mailing Address - Country:US
Mailing Address - Phone:314-401-2424
Mailing Address - Fax:
Practice Address - Street 1:5078 TOWNE CENTRE DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2741
Practice Address - Country:US
Practice Address - Phone:314-401-2424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-28
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO116100225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant