Provider Demographics
NPI:1568410785
Name:FIFE, STUART M (PT)
Entity Type:Individual
Prefix:MR
First Name:STUART
Middle Name:M
Last Name:FIFE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 MALL TER
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-3602
Mailing Address - Country:US
Mailing Address - Phone:912-239-6140
Mailing Address - Fax:912-335-3539
Practice Address - Street 1:6 MALL TER
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3602
Practice Address - Country:US
Practice Address - Phone:912-239-6140
Practice Address - Fax:912-335-3539
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT004325225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA847347304AMedicaid
GA65BBCGGMedicare ID - Type Unspecified
GAP39700Medicare UPIN