Provider Demographics
NPI:1124138839
Name:STUART, JEFFERY D (PT)
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:D
Last Name:STUART
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15008 9TH PL NE
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98155-7006
Mailing Address - Country:US
Mailing Address - Phone:206-367-2438
Mailing Address - Fax:
Practice Address - Street 1:194 SUNSET AVE
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-4134
Practice Address - Country:US
Practice Address - Phone:425-776-3348
Practice Address - Fax:425-776-3384
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPT00002908OtherLICENSE #