Provider Demographics
NPI:1245397876
Name:SWANCOAT, CELESTE NANETTE (PT)
Entity type:Individual
Prefix:MS
First Name:CELESTE
Middle Name:NANETTE
Last Name:SWANCOAT
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 1:442 N LAKEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-3029
Mailing Address - Country:US
Mailing Address - Phone:714-989-8764
Mailing Address - Fax:714-998-8958
Practice Address - Street 1:442 N LAKEVIEW AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-3029
Practice Address - Country:US
Practice Address - Phone:714-989-8764
Practice Address - Fax:714-998-8958
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13729225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist