Kristina Swallow

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

2011030847 Issued in MO

Practice address

11960 Westline Industrial Dr
Suite 201
Saint Louis, MO 63146-3209

Phone

(866) 433-9555

NPI assigned

May 21, 2015

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Kristina Luczak Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Supplemental Health Care

  • Adult Care Home Facility
  • Saint Louis, MO
  • NPI 1902129653
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1432166400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702857600000",
    "number": "1477932598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4290 GRAVOIS RD",
            "city": "HOUSE SPRINGS",
            "state": "MO",
            "postal_code": "630512301",
            "telephone_number": "636-671-3382"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11960 WESTLINE INDUSTRIAL DR",
            "address_2": "SUITE 201",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631463209",
            "telephone_number": "866-433-9555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SWALLOW",
        "first_name": "KRISTINA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-05-21",
        "last_updated": "2023-12-18",
        "certification_date": "2023-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MO",
            "license": "2011030847",
            "primary": true
        },
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "MO",
            "license": "2011030847",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTINA",
            "last_name": "LUCZAK",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Dragan M Svrakic, MD
• SW Anesthesia LLC
• SW Living LLC
• Carley M Swabby
• Ashley Swain
• Aleksandra Swan, AGNP
• Erin Swan, MD
• Heather Janette Swan, L.P.T.A
• Hubert Santiago Swana, MD
• Debra J Swanger, CRNA

• Physical Therapy Assistant in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Physical Therapy Assistant in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.