Provider Demographics
NPI:1235316019
Name:STEWMAN, KERRY J
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:J
Last Name:STEWMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5051 CASTELLO DR
Mailing Address - Street 2:SUITE 208
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-8982
Mailing Address - Country:US
Mailing Address - Phone:239-273-0997
Mailing Address - Fax:
Practice Address - Street 1:5051 CASTELLO DR
Practice Address - Street 2:SUITE 208
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-8982
Practice Address - Country:US
Practice Address - Phone:239-273-0997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-24
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA27303225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist