Provider Demographics
NPI:1205251162
Name:SWANDER, TARYN (DPT)
Entity type:Individual
Prefix:
First Name:TARYN
Middle Name:
Last Name:SWANDER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:TARYN
Other - Middle Name:
Other - Last Name:ZACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:5300 DERRY ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-3576
Mailing Address - Country:US
Mailing Address - Phone:717-839-2110
Mailing Address - Fax:717-565-1102
Practice Address - Street 1:3250 HARDEN STREET EXT
Practice Address - Street 2:SUITE 100
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6842
Practice Address - Country:US
Practice Address - Phone:803-509-6389
Practice Address - Fax:803-509-6390
Is Sole Proprietor?:No
Enumeration Date:2014-02-28
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7291225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ46377C803Medicare Oscar/Certification