Provider Demographics
NPI:1457411316
Name:SWISHER, DONNA JEAN (PT)
Entity Type:Individual
Prefix:MS
First Name:DONNA
Middle Name:JEAN
Last Name:SWISHER
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 1:3056 MACAULAY STREET
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106
Mailing Address - Country:US
Mailing Address - Phone:619-523-6767
Mailing Address - Fax:619-523-6769
Practice Address - Street 1:3156 SPORTS ARENA BLVD.
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110
Practice Address - Country:US
Practice Address - Phone:619-523-6767
Practice Address - Fax:619-523-6769
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT14508225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA330978151OtherTRICARE
CA330978151OtherTAX ID
CA0PT145080OtherBLUE SHIELD
CA127149500OtherDEPT OF LABOR OWCP
CAPT14508OtherLICENSE NUMBER
CAW19410Medicare PIN
CA0PT145080OtherBLUE SHIELD