Provider Demographics
NPI:1811032873
Name:SWAGGERT, JUSTIN LEE (ATC)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:LEE
Last Name:SWAGGERT
Suffix:
Gender:M
Credentials:ATC
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Mailing Address - Street 1:2545 ALDRICH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55405-2925
Mailing Address - Country:US
Mailing Address - Phone:651-334-9128
Mailing Address - Fax:
Practice Address - Street 1:516 15TH AVE SE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0130
Practice Address - Country:US
Practice Address - Phone:612-625-0649
Practice Address - Fax:612-626-4789
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer