Provider Demographics
NPI:1861043416
Name:SWANSTROM, MARY ESTHER (ATC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ESTHER
Last Name:SWANSTROM
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8380 EL MUNDO ST APT 415
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-4627
Mailing Address - Country:US
Mailing Address - Phone:773-499-9449
Mailing Address - Fax:
Practice Address - Street 1:8380 EL MUNDO ST APT 415
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-4627
Practice Address - Country:US
Practice Address - Phone:773-499-9449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-25
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096.0045772255A2300X
TXAT83162255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer