Provider Demographics
NPI:1487944195
Name:SWIM, MARIA RENEE
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:RENEE
Last Name:SWIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1675 SOUTHDALE CTR
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-7015
Mailing Address - Country:US
Mailing Address - Phone:952-922-3600
Mailing Address - Fax:952-922-3600
Practice Address - Street 1:1675 SOUTHDALE CTR
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-7015
Practice Address - Country:US
Practice Address - Phone:952-922-3600
Practice Address - Fax:952-922-3600
Is Sole Proprietor?:No
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN610031659225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist