Provider Demographics
NPI:1851815823
Name:SWIDERSKI, SADIE (DPT)
Entity Type:Individual
Prefix:
First Name:SADIE
Middle Name:
Last Name:SWIDERSKI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 S DILLARD ST
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-3523
Mailing Address - Country:US
Mailing Address - Phone:407-614-8898
Mailing Address - Fax:
Practice Address - Street 1:214 S DILLARD ST
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-3523
Practice Address - Country:US
Practice Address - Phone:407-614-8898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-01
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10783225100000X
MN4531225100000X
FL36700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist