Provider Demographics
NPI:1912256355
Name:SWANSEN, TAYLA ANNE
Entity Type:Individual
Prefix:
First Name:TAYLA
Middle Name:ANNE
Last Name:SWANSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TAYLA
Other - Middle Name:ANNE
Other - Last Name:DIPRIMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:256 GROVELAND ST
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-6628
Mailing Address - Country:US
Mailing Address - Phone:603-339-4591
Mailing Address - Fax:
Practice Address - Street 1:87 STILES RD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-2899
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-30
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8558225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant