Provider Demographics
NPI:1689099632
Name:STEWART, JANELLE E (LMT, PTA)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:E
Last Name:STEWART
Suffix:
Gender:F
Credentials:LMT, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 S GRAND ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17044-2311
Mailing Address - Country:US
Mailing Address - Phone:717-994-1276
Mailing Address - Fax:
Practice Address - Street 1:713 W 4TH ST
Practice Address - Street 2:
Practice Address - City:LEWISTOWN
Practice Address - State:PA
Practice Address - Zip Code:17044-1984
Practice Address - Country:US
Practice Address - Phone:717-994-1276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-27
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG001919225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist