Provider Demographics
NPI:1922316348
Name:SWINDALE, KEVIN ALAN (CPTA)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:ALAN
Last Name:SWINDALE
Suffix:
Gender:F
Credentials:CPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 W MARKET ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:OSAGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66523-1277
Mailing Address - Country:US
Mailing Address - Phone:785-528-1123
Mailing Address - Fax:785-528-4123
Practice Address - Street 1:104 W MARKET ST
Practice Address - Street 2:SUITE B
Practice Address - City:OSAGE CITY
Practice Address - State:KS
Practice Address - Zip Code:66523-1277
Practice Address - Country:US
Practice Address - Phone:785-528-1123
Practice Address - Fax:785-528-4123
Is Sole Proprietor?:No
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1400751225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS20-5322594OtherCOMPANY TAX ID#
KS200431220AOtherKMAP GROUP NUMBER
KS1235242460OtherGROUP NPI
KS20-5322594OtherCOMPANY TAX ID#