Provider Demographics
NPI:1588608236
Name:STEWART, LINDA D (PT)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:D
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 1:1083 PRAIRIE ZINNIA DR
Mailing Address - Street 2:
Mailing Address - City:BERNALILLO
Mailing Address - State:NM
Mailing Address - Zip Code:87004-5801
Mailing Address - Country:US
Mailing Address - Phone:205-901-0743
Mailing Address - Fax:
Practice Address - Street 1:1083 PRAIRIE ZINNIA DR
Practice Address - Street 2:
Practice Address - City:BERNALILLO
Practice Address - State:NM
Practice Address - Zip Code:87004-5801
Practice Address - Country:US
Practice Address - Phone:505-933-7994
Practice Address - Fax:505-930-7136
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPT4211225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51502735OtherBCBS
AL51531831OtherBCBS
AL51502735OtherBCBS
AL51531831OtherBCBS