Provider Demographics
NPI:1477559813
Name:STEWART, KATHLEEN (PT)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:
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 1:2875 BARN RD
Mailing Address - Street 2:STE 100
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-6361
Mailing Address - Country:US
Mailing Address - Phone:540-639-5786
Mailing Address - Fax:540-633-0787
Practice Address - Street 1:2875 BARN RD
Practice Address - Street 2:STE 100
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-6361
Practice Address - Country:US
Practice Address - Phone:540-639-5786
Practice Address - Fax:540-633-0787
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0105001727225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA064824OtherANTHEM
VA496604Medicare ID - Type Unspecified