Provider Demographics
NPI:1477511210
Name:STEWART, VIRGINIA A (PT)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:A
Last Name:STEWART
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:L
Other - Last Name:ALLDREDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2621 QUEENS HOLLOW CT
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-6826
Mailing Address - Country:US
Mailing Address - Phone:334-279-5757
Mailing Address - Fax:334-279-1257
Practice Address - Street 1:3442 EASTDALE CIR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-2163
Practice Address - Country:US
Practice Address - Phone:334-279-5757
Practice Address - Fax:334-279-1257
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH1444225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-32302OtherBCBS #
AL051532302Medicare ID - Type UnspecifiedMEDICARE #