Provider Demographics
NPI:1013774447
Name:SWANSTROM, AMANDA POLLOCK (PT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:POLLOCK
Last Name:SWANSTROM
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 1:2113 SW ROBERTS CT
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64082-4133
Mailing Address - Country:US
Mailing Address - Phone:816-210-1062
Mailing Address - Fax:
Practice Address - Street 1:12701 PFLUMM RD
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-2317
Practice Address - Country:US
Practice Address - Phone:913-490-5035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
11-02639225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist