Provider Demographics
NPI:1619706579
Name:SWIM, CONNOR (DPT)
Entity type:Individual
Prefix:
First Name:CONNOR
Middle Name:
Last Name:SWIM
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17331 E 40 HWY STE 105
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-6444
Mailing Address - Country:US
Mailing Address - Phone:816-478-2333
Mailing Address - Fax:816-478-2335
Practice Address - Street 1:17331 E US HIGHWAY 40 STE 105
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-6444
Practice Address - Country:US
Practice Address - Phone:816-478-2333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-30
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
MOCP033140T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist