Provider Demographics
NPI:1639483415
Name:STEWART, LAURAANNE JORDAN (DPT)
Entity Type:Individual
Prefix:
First Name:LAURAANNE
Middle Name:JORDAN
Last Name:STEWART
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LAURAANNE
Other - Middle Name:JORDAN
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-238-3473
Practice Address - Street 1:939 JOE FRANK HARRIS PKWY SE
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-2130
Practice Address - Country:US
Practice Address - Phone:770-383-9734
Practice Address - Fax:770-383-9831
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT10037225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist