Provider Demographics
NPI:1922008648
Name:MALLOCH-SWIDERSKI, TRACY (PT)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:MALLOCH-SWIDERSKI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 GRANITE RUN DRIVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-6823
Mailing Address - Country:US
Mailing Address - Phone:717-560-4200
Mailing Address - Fax:175-604-1597
Practice Address - Street 1:231 GRANITE RUN DRIVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-6823
Practice Address - Country:US
Practice Address - Phone:717-560-4200
Practice Address - Fax:717-560-4159
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT010816L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00026989801OtherUNIVERA
PAP00170363OtherRR MEDICARE
PA1011305770001Medicaid
PA19511OtherBLUE SHIELD
PAP00170363OtherRR MEDICARE
S65274Medicare UPIN
PA19511OtherBLUE SHIELD