Provider Demographics
NPI:1952704835
Name:SWEN, ROBER WESLEY (PT, DPT, OCS)
Entity Type:Individual
Prefix:DR
First Name:ROBER
Middle Name:WESLEY
Last Name:SWEN
Suffix:
Gender:M
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 ROSSMONT DR
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-7217
Mailing Address - Country:US
Mailing Address - Phone:909-884-1500
Mailing Address - Fax:
Practice Address - Street 1:1375 CAMINO REAL STE 130
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-2764
Practice Address - Country:US
Practice Address - Phone:909-884-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-06
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC155182251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic