Provider Demographics
NPI:1508661018
Name:WILENT, STEWART (DPT, PT)
Entity type:Individual
Prefix:
First Name:STEWART
Middle Name:
Last Name:WILENT
Suffix:
Gender:
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10121 SE SUNNYSIDE RD STE 208
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-5750
Mailing Address - Country:US
Mailing Address - Phone:503-668-5321
Mailing Address - Fax:503-668-9742
Practice Address - Street 1:16621 CHAMPION WAY STE 100
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:OR
Practice Address - Zip Code:97055-7258
Practice Address - Country:US
Practice Address - Phone:503-668-5321
Practice Address - Fax:503-668-9742
Is Sole Proprietor?:No
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR65601225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist