Provider Demographics
NPI:1063522647
Name:STEWART, RICHARD (PT, DPT, OCS)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:STEWART
Suffix:
Gender:M
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 RIDING TRL
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-9165
Mailing Address - Country:US
Mailing Address - Phone:704-578-1374
Mailing Address - Fax:
Practice Address - Street 1:703 N US 29 HWY
Practice Address - Street 2:
Practice Address - City:CHINA GROVE
Practice Address - State:NC
Practice Address - Zip Code:28023-2617
Practice Address - Country:US
Practice Address - Phone:704-859-5040
Practice Address - Fax:704-856-8815
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
NCP10199225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC10199OtherLICENSE #