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Individual
MAUD IZETTE SWAN
Active
Individual
MAUD IZETTE SWAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT7502
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
165922
WA STATE L&I
WA
05
—
8331639
—
WA
Enumeration date
08/31/2006
Last updated
11/24/2015
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