Provider Demographics
NPI:1881730547
Name:SWARTZ, GREGORY GENE (PT)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:GENE
Last Name:SWARTZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13010 WHITE AVE
Mailing Address - Street 2:STE. A.
Mailing Address - City:GRANDVIEW
Mailing Address - State:MO
Mailing Address - Zip Code:64030-2667
Mailing Address - Country:US
Mailing Address - Phone:816-761-3379
Mailing Address - Fax:816-763-8306
Practice Address - Street 1:13010 WHITE AVE
Practice Address - Street 2:STE. A.
Practice Address - City:GRANDVIEW
Practice Address - State:MO
Practice Address - Zip Code:64030-2667
Practice Address - Country:US
Practice Address - Phone:816-761-3379
Practice Address - Fax:816-763-8306
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO RO116225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO25652018OtherBLUE CROSS/BLUE SHIELD
MOJ70A830AMedicare ID - Type UnspecifiedMEDICARE PROVIDER #