Provider Demographics
NPI:1053425967
Name:STEWART, DINA MARIA (LMT)
Entity type:Individual
Prefix:
First Name:DINA
Middle Name:MARIA
Last Name:STEWART
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1781
Mailing Address - Street 2:
Mailing Address - City:ANNA MARIA
Mailing Address - State:FL
Mailing Address - Zip Code:34216-1781
Mailing Address - Country:US
Mailing Address - Phone:941-778-6060
Mailing Address - Fax:
Practice Address - Street 1:3639 CORTEZ RD W
Practice Address - Street 2:SUITE 106
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-3103
Practice Address - Country:US
Practice Address - Phone:941-737-9797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA0032272225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA0032272OtherLISCENSED MASSAGE THERAPI