Provider Demographics
NPI:1689805459
Name:STEWART, KRISTINE MARIE (PTA)
Entity Type:Individual
Prefix:MS
First Name:KRISTINE
Middle Name:MARIE
Last Name:STEWART
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9355 S PARKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-2858
Mailing Address - Country:US
Mailing Address - Phone:480-390-2003
Mailing Address - Fax:
Practice Address - Street 1:9355 S PARKSIDE DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-2858
Practice Address - Country:US
Practice Address - Phone:480-390-2003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7968A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant