Provider Demographics
NPI:1104855782
Name:STEWART, TODD (ATC)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:
Last Name:STEWART
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 MATHEWS DR
Mailing Address - Street 2:STE D5
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-3734
Mailing Address - Country:US
Mailing Address - Phone:843-681-5640
Mailing Address - Fax:843-681-5631
Practice Address - Street 1:38 SHERIDAN PARK CIR
Practice Address - Street 2:STE E
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-7022
Practice Address - Country:US
Practice Address - Phone:843-815-5628
Practice Address - Fax:843-681-5631
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC630174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist