Provider Demographics
NPI:1922375955
Name:SWORD, JUSTIN (MS, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:SWORD
Suffix:
Gender:M
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5530 S ELLIS AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-1402
Mailing Address - Country:US
Mailing Address - Phone:773-702-3875
Mailing Address - Fax:773-834-4470
Practice Address - Street 1:5530 S ELLIS AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1402
Practice Address - Country:US
Practice Address - Phone:773-702-3875
Practice Address - Fax:773-834-4470
Is Sole Proprietor?:No
Enumeration Date:2011-11-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096.0024232255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer