Provider Demographics
NPI:1770929697
Name:SWANK, SHAWN D (LMT, NCMT)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:D
Last Name:SWANK
Suffix:
Gender:M
Credentials:LMT, NCMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 HENRY ST
Mailing Address - Street 2:
Mailing Address - City:BELLE VERNON
Mailing Address - State:PA
Mailing Address - Zip Code:15012-1418
Mailing Address - Country:US
Mailing Address - Phone:724-208-9403
Mailing Address - Fax:
Practice Address - Street 1:193 FINLEY RD
Practice Address - Street 2:
Practice Address - City:BELLE VERNON
Practice Address - State:PA
Practice Address - Zip Code:15012-3822
Practice Address - Country:US
Practice Address - Phone:724-930-8060
Practice Address - Fax:724-930-8083
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-18
Last Update Date:2013-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG005931225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist