Provider Demographics
NPI:1851345219
Name:SWANSON, HEATHER LYN (MPT)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:LYN
Last Name:SWANSON
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:LYN
Other - Last Name:TAPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:20667 ELLEN CT
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1188
Mailing Address - Country:US
Mailing Address - Phone:248-467-7247
Mailing Address - Fax:
Practice Address - Street 1:23852 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-1829
Practice Address - Country:US
Practice Address - Phone:313-565-4222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010141225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
236613Medicare ID - Type Unspecified