Provider Demographics
NPI:1275656555
Name:STEWART, AMY L (MPT)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:L
Last Name:STEWART
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:L
Other - Last Name:PREST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:4171 LAS PALMAS SQUARE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:91945
Mailing Address - Country:US
Mailing Address - Phone:858-646-3415
Mailing Address - Fax:858-677-9818
Practice Address - Street 1:4171 LAS PALMAS SQUARE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:91945
Practice Address - Country:US
Practice Address - Phone:858-646-3415
Practice Address - Fax:858-677-9818
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 29381225100000X
CAPT29381225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist