Provider Demographics
NPI:1417911983
Name:STEWART, HETTIE HAGUE (PT)
Entity Type:Individual
Prefix:
First Name:HETTIE
Middle Name:HAGUE
Last Name:STEWART
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-1206
Mailing Address - Country:US
Mailing Address - Phone:770-456-3472
Mailing Address - Fax:770-456-3230
Practice Address - Street 1:605 NORTH AVE
Practice Address - Street 2:
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-1206
Practice Address - Country:US
Practice Address - Phone:770-456-3472
Practice Address - Fax:770-456-3230
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007170225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist