Provider Demographics
NPI:1831316991
Name:SWAN, JULIE ANN (PT)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:SWAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14640 JOHN HUMPHREY DR
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-2698
Mailing Address - Country:US
Mailing Address - Phone:708-403-5199
Mailing Address - Fax:708-403-7274
Practice Address - Street 1:14640 JOHN HUMPHREY DR
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-2698
Practice Address - Country:US
Practice Address - Phone:708-403-5199
Practice Address - Fax:708-403-7274
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ69402251P0200X
IL0700135832251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ123277Medicaid
AZ544307OtherHCA PROVIDER ID