Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | PT00005395 | WA |
NPI | 1154562601 |
---|---|
Provider Name | Dr. Laurie Swan |
First Address | Puyallup, WA 98373-1460 |
Second Address | Puyallup, WA 98373-1460 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2009 |
Last Update Date | 12/03/2009 |