Provider Demographics
NPI:1003423435
Name:SWANSON, PATRICIA HAYES (PT)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:HAYES
Last Name:SWANSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 CLAPBOARD HILL RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72227-3015
Mailing Address - Country:US
Mailing Address - Phone:501-412-1767
Mailing Address - Fax:
Practice Address - Street 1:1401 LABELLE DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-2315
Practice Address - Country:US
Practice Address - Phone:501-444-2390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT1028225100000X
AR1028225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist