Provider Demographics
NPI:1336240597
Name:STUART, HAROLD BRYAN (PT)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:BRYAN
Last Name:STUART
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 FREDERICA ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-3050
Mailing Address - Country:US
Mailing Address - Phone:270-684-2733
Mailing Address - Fax:270-684-3326
Practice Address - Street 1:920 FREDERICA ST
Practice Address - Street 2:SUITE 104
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-3050
Practice Address - Country:US
Practice Address - Phone:270-684-2733
Practice Address - Fax:270-684-3326
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY002466225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY5025501Medicare PIN