Provider Demographics
NPI:1922861962
Name:STEWART, JENNIFER KRISTA (PTA)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:KRISTA
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 1:11320 N LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-9418
Mailing Address - Country:US
Mailing Address - Phone:415-652-7885
Mailing Address - Fax:
Practice Address - Street 1:2431 BROADWAY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3018
Practice Address - Country:US
Practice Address - Phone:425-252-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-02
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60340820225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant