Provider Demographics
NPI:1972725992
Name:SWANSON, CHRISTINA MARIE (ATC)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:MARIE
Last Name:SWANSON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10199 E. EDWARDSVILLE RD.
Mailing Address - Street 2:
Mailing Address - City:GERMAN VALLEY
Mailing Address - State:IL
Mailing Address - Zip Code:61039
Mailing Address - Country:US
Mailing Address - Phone:815-362-9005
Mailing Address - Fax:
Practice Address - Street 1:555 SPARTAN TRAIL
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178
Practice Address - Country:US
Practice Address - Phone:815-899-8148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer