Provider Demographics
NPI:1700251618
Name:SWANSON, CHRISTIAN MARK (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:MARK
Last Name:SWANSON
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 25TH AVE
Mailing Address - Street 2:101
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-3606
Mailing Address - Country:US
Mailing Address - Phone:408-427-5422
Mailing Address - Fax:
Practice Address - Street 1:77 BATTERY ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94111-5537
Practice Address - Country:US
Practice Address - Phone:415-318-8138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43375225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist