Provider Demographics
NPI:1477027878
Name:STEWART, JEREMY MICHAEL (PHYSICAL THERAPY)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:MICHAEL
Last Name:STEWART
Suffix:
Gender:M
Credentials:PHYSICAL THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 S IDAHO RD STE 101
Mailing Address - Street 2:
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85119-6497
Mailing Address - Country:US
Mailing Address - Phone:480-983-0877
Mailing Address - Fax:480-983-3172
Practice Address - Street 1:1075 S IDAHO RD
Practice Address - Street 2:
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85119
Practice Address - Country:US
Practice Address - Phone:480-983-0877
Practice Address - Fax:480-983-3172
Is Sole Proprietor?:No
Enumeration Date:2019-01-18
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT30441225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist