Provider Demographics
NPI:1154353878
Name:STEWART, BEVERLY F
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:F
Last Name:STEWART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1036 OLEAN RD
Mailing Address - Street 2:
Mailing Address - City:EAST AURORA
Mailing Address - State:NY
Mailing Address - Zip Code:14052
Mailing Address - Country:US
Mailing Address - Phone:716-655-0165
Mailing Address - Fax:716-655-4775
Practice Address - Street 1:1036 OLEAN RD
Practice Address - Street 2:
Practice Address - City:EAST AURORA
Practice Address - State:NY
Practice Address - Zip Code:14052-9738
Practice Address - Country:US
Practice Address - Phone:716-655-0165
Practice Address - Fax:716-655-4775
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002769225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA4756Medicare PIN