Provider Demographics
NPI:1114638855
Name:STUART, RODGER
Entity Type:Individual
Prefix:
First Name:RODGER
Middle Name:
Last Name:STUART
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15720 MEADOW RD UNIT J6
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98087-6564
Mailing Address - Country:US
Mailing Address - Phone:408-533-2714
Mailing Address - Fax:
Practice Address - Street 1:31121 U.S. ROUTE 2
Practice Address - Street 2:SUITE E
Practice Address - City:SULTAN
Practice Address - State:WA
Practice Address - Zip Code:98294
Practice Address - Country:US
Practice Address - Phone:360-799-0958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant