Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 008351 | GA |
NPI | 1003040049 |
---|---|
Provider Name | Mr. Nicholas B Swanner |
First Address | Roswell, GA 30076-1395 |
Second Address | Roswell, GA 30076-1395 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2009 |
Last Update Date | 24/12/2019 |