Provider Demographics
NPI:1295925758
Name:SWAIN, PAULA (PT)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:SWAIN
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 1:13106 SE 240TH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031-9210
Mailing Address - Country:US
Mailing Address - Phone:253-631-1933
Mailing Address - Fax:
Practice Address - Street 1:13106 SE 240TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98031-9210
Practice Address - Country:US
Practice Address - Phone:253-631-1933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00003339225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8337685Medicaid
WAGAB32365Medicare PIN
WA8337685Medicaid