Provider Demographics
NPI:1053968222
Name:STEWART PEDIATRIC THERAPY LLC
Entity type:Organization
Organization Name:STEWART PEDIATRIC THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:JILL
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:870-476-9017
Mailing Address - Street 1:151 GREENE 789 RD
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-5990
Mailing Address - Country:US
Mailing Address - Phone:870-476-9017
Mailing Address - Fax:870-362-2018
Practice Address - Street 1:1908 MOCKINGBIRD LANE
Practice Address - Street 2:SUITE A
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450
Practice Address - Country:US
Practice Address - Phone:870-476-9017
Practice Address - Fax:870-362-2018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-22
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty