Provider Demographics
NPI:1447751318
Name:SWANSON, JOHN CARTER (PT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:CARTER
Last Name:SWANSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 ORCHARD LAKE RD STE LL09
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3423
Mailing Address - Country:US
Mailing Address - Phone:248-855-7411
Mailing Address - Fax:248-855-7419
Practice Address - Street 1:6900 ORCHARD LAKE RD STE LL09
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3423
Practice Address - Country:US
Practice Address - Phone:248-855-7411
Practice Address - Fax:248-855-7419
Is Sole Proprietor?:No
Enumeration Date:2018-02-26
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015533225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist