Provider Demographics
NPI:1508233404
Name:STEWART, KATHRYN (PTA)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6811 W SCATTERS WAY
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99623-0878
Mailing Address - Country:US
Mailing Address - Phone:907-841-1479
Mailing Address - Fax:
Practice Address - Street 1:619 S KNIK GOOSE BAY RD
Practice Address - Street 2:SUITE H
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-8075
Practice Address - Country:US
Practice Address - Phone:907-315-7949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-26
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2608225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant