Provider Demographics
NPI:1518909365
Name:STEWART, SUZANNE BAKER (PT)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:BAKER
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:PO BOX 215
Mailing Address - Street 2:
Mailing Address - City:KUNA
Mailing Address - State:ID
Mailing Address - Zip Code:83634-0215
Mailing Address - Country:US
Mailing Address - Phone:208-922-5057
Mailing Address - Fax:
Practice Address - Street 1:333 AVENUE C
Practice Address - Street 2:SUITE 3
Practice Address - City:KUNA
Practice Address - State:ID
Practice Address - Zip Code:83634-2004
Practice Address - Country:US
Practice Address - Phone:208-922-5057
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDRPT-1844225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1654091Medicare ID - Type Unspecified