Basic Information
Provider Information
NPI: 1003003021
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SWINEHART
FirstName: JOSEPH
MiddleName: ROBERT
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 822
Address2:  
City: WHITE CLOUD
State: MI
PostalCode: 493490822
CountryCode: US
TelephoneNumber: 2316522343
FaxNumber: 2316522343
Practice Location
Address1: 609 PICKERAL LAKE DR
Address2:  
City: NEWAYGO
State: MI
PostalCode: 493379152
CountryCode: US
TelephoneNumber: 2316522343
FaxNumber: 2316522343
Other Information
ProviderEnumerationDate: 10/03/2007
LastUpdateDate: 10/17/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X5501010140MIY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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