Provider Demographics
NPI:1922193291
Name:SWARTZ, NICOLE ANN (MSPT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ANN
Last Name:SWARTZ
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7825 3RD ST N
Mailing Address - Street 2:STE 105
Mailing Address - City:OAKDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55128-5444
Mailing Address - Country:US
Mailing Address - Phone:877-609-0123
Mailing Address - Fax:888-425-0398
Practice Address - Street 1:10665 VILLAGE LAKE RD
Practice Address - Street 2:
Practice Address - City:WINDERMERE
Practice Address - State:FL
Practice Address - Zip Code:34786-5935
Practice Address - Country:US
Practice Address - Phone:813-738-5870
Practice Address - Fax:888-425-0398
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 203882251X0800X
FLPT20388225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY007CZMedicare PIN
Q54921Medicare UPIN