Provider Demographics
NPI:1952334484
Name:SWANN, SCOTT ANDREW (PT)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:ANDREW
Last Name:SWANN
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 1:928 DIAMOND SPRINGS RD STE 103
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-6601
Mailing Address - Country:US
Mailing Address - Phone:757-395-1975
Mailing Address - Fax:
Practice Address - Street 1:928 DIAMOND SPRINGS RD STE 103
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-6601
Practice Address - Country:US
Practice Address - Phone:757-395-1975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9175225100000X
VA2305005880225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist