Provider Demographics
NPI:1013099035
Name:SWANSON, MICHAEL DEAN (PT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DEAN
Last Name:SWANSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785 E HOLLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1257
Mailing Address - Country:US
Mailing Address - Phone:509-466-6393
Mailing Address - Fax:509-466-5163
Practice Address - Street 1:785 E HOLLAND AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1257
Practice Address - Country:US
Practice Address - Phone:509-466-6393
Practice Address - Fax:509-466-5163
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008637225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0207458OtherL&I #
WA8455214Medicaid
WA0207458OtherL&I #
WA8455214Medicaid
WA5874430001Medicare NSC