Provider Demographics
NPI:1558471532
Name:STEWART, SUSAN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:SUSAN
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 1:135 CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:WARRIOR
Mailing Address - State:AL
Mailing Address - Zip Code:35180-4137
Mailing Address - Country:US
Mailing Address - Phone:205-631-4002
Mailing Address - Fax:
Practice Address - Street 1:1603 DECATUR HWY
Practice Address - Street 2:STE 103
Practice Address - City:GARDENDALE
Practice Address - State:AL
Practice Address - Zip Code:35071-2302
Practice Address - Country:US
Practice Address - Phone:205-631-4002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18928225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant