Provider Demographics
NPI:1639230634
Name:STEWART, CASEY ANN (LMP)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:ANN
Last Name:STEWART
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3142 SWORD FERN DR NW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-3292
Mailing Address - Country:US
Mailing Address - Phone:360-867-4070
Mailing Address - Fax:
Practice Address - Street 1:1307 VIOLET ST SE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-5710
Practice Address - Country:US
Practice Address - Phone:360-459-7802
Practice Address - Fax:360-459-1216
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00017261225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist