Provider Demographics
NPI:1598303919
Name:STEWART, LYNNE MARIE (LMT)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:MARIE
Last Name:STEWART
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:LYNNE
Other - Middle Name:M
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:1858 WHITE CLIFF DR
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-8185
Mailing Address - Country:US
Mailing Address - Phone:239-634-1100
Mailing Address - Fax:
Practice Address - Street 1:10192 GRAND RIVER RD STE 107
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-6531
Practice Address - Country:US
Practice Address - Phone:810-494-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7501010837225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist