Provider Demographics
NPI:1659037182
Name:STEWART SPORT AND SPINE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:STEWART SPORT AND SPINE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, OCS
Authorized Official - Phone:319-238-1908
Mailing Address - Street 1:502 N ANKENY BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-1755
Mailing Address - Country:US
Mailing Address - Phone:319-238-1908
Mailing Address - Fax:
Practice Address - Street 1:502 N ANKENY BLVD STE 4
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-1755
Practice Address - Country:US
Practice Address - Phone:319-238-1908
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy