Provider Demographics
NPI:1942210232
Name:SWANTON, GAIL LEE (PT M S)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:LEE
Last Name:SWANTON
Suffix:
Gender:F
Credentials:PT M S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 E SHORE RD
Mailing Address - Street 2:
Mailing Address - City:WESTPORT ISLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04578-3517
Mailing Address - Country:US
Mailing Address - Phone:207-350-0160
Mailing Address - Fax:207-882-9071
Practice Address - Street 1:171 E SHORE RD
Practice Address - Street 2:
Practice Address - City:WESTPORT ISLAND
Practice Address - State:ME
Practice Address - Zip Code:04578-3517
Practice Address - Country:US
Practice Address - Phone:207-350-0160
Practice Address - Fax:207-882-9071
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT 179225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME036889OtherANTHEM
ME036889OtherANTHEM