Provider Demographics
NPI:1427424886
Name:STEWART, SAMANTHA A (DPT)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:A
Last Name:STEWART
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95-199 HOAHELE PLACE
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-5544
Mailing Address - Country:US
Mailing Address - Phone:808-674-0500
Mailing Address - Fax:808-674-0511
Practice Address - Street 1:99-128 AIEA HEIGHTS DRIVE
Practice Address - Street 2:STE 207
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-3968
Practice Address - Country:US
Practice Address - Phone:808-487-0487
Practice Address - Fax:808-486-8674
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25606225100000X
HIPT5140225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist