Provider Demographics
NPI:1760963060
Name:STEWART THERAPY
Entity Type:Organization
Organization Name:STEWART THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:PECK-DEVENPORT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-236-2545
Mailing Address - Street 1:5045 W BASELINE RD STE 120
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-7393
Mailing Address - Country:US
Mailing Address - Phone:602-237-1105
Mailing Address - Fax:602-237-1106
Practice Address - Street 1:5045 W BASELINE RD STE 120
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-7393
Practice Address - Country:US
Practice Address - Phone:602-237-1105
Practice Address - Fax:602-237-1106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4222225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty