Provider Demographics
NPI:1417287525
Name:STEWART, AMANDA KLEWENO (PT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:KLEWENO
Last Name:STEWART
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:KLEWENO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1251 FOUNDERS LAKE DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-7645
Mailing Address - Country:US
Mailing Address - Phone:770-554-2307
Mailing Address - Fax:
Practice Address - Street 1:150 ATHENS HWY
Practice Address - Street 2:SUITE 600
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-2277
Practice Address - Country:US
Practice Address - Phone:770-554-2307
Practice Address - Fax:770-554-2309
Is Sole Proprietor?:No
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT9850225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist