Provider Demographics
NPI:1184854481
Name:STEWART, NOLAN PATRICK (DPT)
Entity Type:Individual
Prefix:MR
First Name:NOLAN
Middle Name:PATRICK
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 1:2875 BARN RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-6389
Mailing Address - Country:US
Mailing Address - Phone:540-639-5786
Mailing Address - Fax:540-633-0787
Practice Address - Street 1:2875 BARN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-6389
Practice Address - Country:US
Practice Address - Phone:540-639-5786
Practice Address - Fax:540-633-0787
Is Sole Proprietor?:No
Enumeration Date:2009-07-21
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305205950225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1487759957Medicaid
VA1487759957OtherANTHEM
VA1487759957Medicare NSC