Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 0006382 | GA |
N | 2251P0200X | Physical Therapist - Pediatrics | 32355 | FL |
NPI | 1114088077 |
---|---|
Provider Name | Molly Swafford |
First Address | Winter Park, FL 32792-4825 |
Second Address | Winter Park, FL 32792-4825 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2006 |
Last Update Date | 03/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000827252D | (05) | GA |
318311 | WELLCARE OF GEORGIA (01) | GA |