Provider Demographics
NPI:1659424422
Name:STEWART, DOUGLAS M (DPT)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:M
Last Name:STEWART
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:848 N RAINBOW BLVD
Mailing Address - Street 2:#357
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-1103
Mailing Address - Country:US
Mailing Address - Phone:702-256-9738
Mailing Address - Fax:702-242-5629
Practice Address - Street 1:1505 WIGWAM PKWY
Practice Address - Street 2:SUITE 240
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-8159
Practice Address - Country:US
Practice Address - Phone:702-568-0195
Practice Address - Fax:702-568-0365
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2064225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1659424422Medicaid
NV1659424422Medicaid