Provider Demographics
NPI:1821640657
Name:OSWALT, ENEIDA (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:ENEIDA
Middle Name:
Last Name:OSWALT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1633 E LAKESIDE DR UNIT 133
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-4971
Mailing Address - Country:US
Mailing Address - Phone:480-453-0797
Mailing Address - Fax:
Practice Address - Street 1:1633 E LAKESIDE DR UNIT 133
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-4971
Practice Address - Country:US
Practice Address - Phone:480-453-0797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-11
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-307572251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics