Provider Demographics
NPI:1205985850
Name:STEWART, JUDY LEE (LPTA)
Entity type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:LEE
Last Name:STEWART
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:JUDY
Other - Middle Name:LEE
Other - Last Name:SLANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:42768 NEW BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97870
Mailing Address - Country:US
Mailing Address - Phone:541-893-6924
Mailing Address - Fax:
Practice Address - Street 1:3325 POCAHONTAS RD
Practice Address - Street 2:
Practice Address - City:BAKER CITY
Practice Address - State:OR
Practice Address - Zip Code:97814
Practice Address - Country:US
Practice Address - Phone:541-523-8130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7750225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant