Provider Demographics
NPI:1790034254
Name:STEWART, LEE ANN (DPT)
Entity Type:Individual
Prefix:MRS
First Name:LEE
Middle Name:ANN
Last Name:STEWART
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:LEE
Other - Middle Name:ANN
Other - Last Name:HOLT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:256A ROAD 1282
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38804-7338
Mailing Address - Country:US
Mailing Address - Phone:662-816-8132
Mailing Address - Fax:
Practice Address - Street 1:4381 S EASON BLVD
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801
Practice Address - Country:US
Practice Address - Phone:662-816-8132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-30
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS4380225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist