Provider Demographics
NPI:1972657807
Name:STEWART, JENNIFER TORTORICH (PT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:TORTORICH
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 1:148 CAMBROOKE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-7829
Mailing Address - Country:US
Mailing Address - Phone:601-466-9938
Mailing Address - Fax:
Practice Address - Street 1:6134 HWY 98 WEST
Practice Address - Street 2:SUITE 21
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-6020
Practice Address - Country:US
Practice Address - Phone:601-336-7155
Practice Address - Fax:601-336-7782
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPT04355225100000X
MSPT3116225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist