Provider Demographics
NPI:1194942425
Name:STEWART, STEPHANIE N (PT)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:N
Last Name:STEWART
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CLIFTON GROVE WAY
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-6547
Mailing Address - Country:US
Mailing Address - Phone:802-393-1400
Mailing Address - Fax:
Practice Address - Street 1:10131 W COLONIAL DR
Practice Address - Street 2:STE 20
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4221
Practice Address - Country:US
Practice Address - Phone:407-292-2156
Practice Address - Fax:407-241-2868
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0400003705225100000X
FLPT 25864225100000X
SC10756225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist