Provider Demographics
NPI:1770148884
Name:STEWART, ANNIE GRACE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:ANNIE
Middle Name:GRACE
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 1:701 HARRISON ST APT 120
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-3050
Mailing Address - Country:US
Mailing Address - Phone:570-898-5593
Mailing Address - Fax:
Practice Address - Street 1:1770 BATHGATE RD
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-7334
Practice Address - Country:US
Practice Address - Phone:484-884-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-03
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT02775222251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPT027522OtherCOMMONWEALTH OF PENNSYLVANIA