Provider Demographics
NPI:1922439983
Name:SWINT, BRYAN (CPO/L, MS)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:SWINT
Suffix:
Gender:M
Credentials:CPO/L, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2809 N HURSTBOURNE PKWY
Mailing Address - Street 2:111
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-1283
Mailing Address - Country:US
Mailing Address - Phone:502-882-9300
Mailing Address - Fax:502-882-8375
Practice Address - Street 1:2809 N HURSTBOURNE PKWY
Practice Address - Street 2:111
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-1283
Practice Address - Country:US
Practice Address - Phone:502-882-9300
Practice Address - Fax:502-882-8375
Is Sole Proprietor?:No
Enumeration Date:2013-12-02
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYLO-285222Z00000X
KYLPO-308224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100248990Medicaid
6689570001Medicare NSC