Provider Demographics
NPI:1821561564
Name:STEWART, BRANDI (PTA, CKTP)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:PTA, CKTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 W PERRY ST
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-2035
Mailing Address - Country:US
Mailing Address - Phone:602-332-1953
Mailing Address - Fax:
Practice Address - Street 1:307 W PERRY ST
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-2035
Practice Address - Country:US
Practice Address - Phone:602-332-1953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-04
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH011305225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant