Provider Demographics
NPI:1821418872
Name:SWAYZE, MARY ROB (DPT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ROB
Last Name:SWAYZE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:CATHLEEN
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 9049
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-9049
Mailing Address - Country:US
Mailing Address - Phone:303-415-4101
Mailing Address - Fax:303-415-4769
Practice Address - Street 1:2150 STADIUM DRIVE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80309-9019
Practice Address - Country:US
Practice Address - Phone:303-315-9900
Practice Address - Fax:303-315-9902
Is Sole Proprietor?:No
Enumeration Date:2014-04-17
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT5263225100000X
COPTL.0015714225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist