Provider Demographics
NPI:1982206496
Name:VANSWEARINGEN, ELOUISE (PT)
Entity Type:Individual
Prefix:
First Name:ELOUISE
Middle Name:
Last Name:VANSWEARINGEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4515 E PERSHING BLVD
Mailing Address - Street 2:UNIT C
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-6093
Mailing Address - Country:US
Mailing Address - Phone:406-570-0359
Mailing Address - Fax:
Practice Address - Street 1:3710 DOVER RD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-1609
Practice Address - Country:US
Practice Address - Phone:406-570-0359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1927225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist