Active NPI
Autumn Swansen
- Physical Therapist
- Decatur, IL
National Provider Identifier
1417320730
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 070020332
- Practice address
- 3004 N Water St Ste C
Decatur, IL 62526-1960 - Phone
- (217) 233-0030
- Fax
- (217) 233-0331
- NPI assigned
- Nov 9, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 070020332 | IL | Primary |
Addresses
Primary practice location
3004 N Water St Ste C
Decatur, IL 62526-1960
Mailing address
600 Oakmont LN Ste 600C
Westmont, IL 60559-5548
Phone (630) 575-6250
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070020332 | IL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1447027200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1558310400000",
"number": "1417320730",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "600 OAKMONT LN STE 600C",
"city": "WESTMONT",
"state": "IL",
"postal_code": "605595548",
"telephone_number": "630-575-6250"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3004 N WATER ST STE C",
"city": "DECATUR",
"state": "IL",
"postal_code": "625261960",
"telephone_number": "217-233-0030",
"fax_number": "217-233-0331"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SWANSEN",
"first_name": "AUTUMN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-11-09",
"last_updated": "2019-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "070020332",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Decatur, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.