Provider Demographics
NPI:1952691743
Name:SWANSON, SANDRA ANNE (LMT/LICENSED MASSAGE)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:ANNE
Last Name:SWANSON
Suffix:
Gender:F
Credentials:LMT/LICENSED MASSAGE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1694 PENFIELD RD.
Mailing Address - Street 2:CATALYST HEALTH GROUP
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1694 PENFIELD RD.
Practice Address - Street 2:CATALYST HEALTH GROUP
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625
Practice Address - Country:US
Practice Address - Phone:585-943-7664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-13
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023729225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY023729OtherNEW YORK STATE EDUCATION DEPARTMENT