Provider Demographics
NPI:1457709990
Name:STEWART, JESSICA (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:STEWART
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26837 MAPLE VALLEY BLACK DIAMOND RD SE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-9917
Mailing Address - Country:US
Mailing Address - Phone:425-413-4427
Mailing Address - Fax:425-413-4402
Practice Address - Street 1:701 M ST NE STE 102
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-4592
Practice Address - Country:US
Practice Address - Phone:253-833-8766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist