Provider Demographics
NPI:1841399805
Name:SWAYNE, MEREDITH LIN (LAT, ATC)
Entity Type:Individual
Prefix:MS
First Name:MEREDITH
Middle Name:LIN
Last Name:SWAYNE
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 VIEWCREST DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75228-4215
Mailing Address - Country:US
Mailing Address - Phone:682-597-2093
Mailing Address - Fax:
Practice Address - Street 1:9750 FERGUSON RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75228-3818
Practice Address - Country:US
Practice Address - Phone:214-324-3607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2012-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT30882255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX010502041OtherA.T.C. CERTIFICATION
TXAT3088OtherATHLETIC TRAINER