Provider Demographics
NPI:1972336071
Name:STEWART, BRYAN N (DPT)
Entity type:Individual
Prefix:MS
First Name:BRYAN
Middle Name:N
Last Name:STEWART
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23317 ANTLER LAKE DR
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-6997
Mailing Address - Country:US
Mailing Address - Phone:318-218-2014
Mailing Address - Fax:954-944-0308
Practice Address - Street 1:2243 N MIAMI AVE STE 110
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33127-5823
Practice Address - Country:US
Practice Address - Phone:786-684-8796
Practice Address - Fax:954-281-9019
Is Sole Proprietor?:No
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT41810225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist