Provider Demographics
NPI:1821245317
Name:STEWART, CARRIE E (PT)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:E
Last Name:STEWART
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 N FRONT ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-1537
Mailing Address - Country:US
Mailing Address - Phone:901-577-9484
Mailing Address - Fax:901-577-9483
Practice Address - Street 1:440 N FRONT ST
Practice Address - Street 2:SUITE 102
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105-1537
Practice Address - Country:US
Practice Address - Phone:901-577-9484
Practice Address - Fax:901-577-9483
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2010-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7290225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3077388OtherBLUE CROSS BLUE SHIELD OF TENNESSEE
TN446569Medicare PIN