Provider Demographics
NPI:1114382041
Name:STEWART, JUNKO (PTA)
Entity Type:Individual
Prefix:
First Name:JUNKO
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2907 W BAY TO BAY BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-1706
Mailing Address - Country:US
Mailing Address - Phone:813-250-1208
Mailing Address - Fax:813-250-1209
Practice Address - Street 1:2907 W BAY TO BAY BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-1706
Practice Address - Country:US
Practice Address - Phone:813-250-1208
Practice Address - Fax:813-250-1209
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-18
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA25853225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant