Provider Demographics
NPI:1689678476
Name:STEWART, PHILLIP KENT (PT)
Entity Type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:KENT
Last Name:STEWART
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-5259
Mailing Address - Country:US
Mailing Address - Phone:256-543-2981
Mailing Address - Fax:256-543-0277
Practice Address - Street 1:426 S 4TH ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-5259
Practice Address - Country:US
Practice Address - Phone:256-543-2981
Practice Address - Fax:256-543-0277
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH1014225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000071287Medicare ID - Type Unspecified