Provider Demographics
NPI:1801973995
Name:STEWART, RICK D (PT)
Entity type:Individual
Prefix:MR
First Name:RICK
Middle Name:D
Last Name:STEWART
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:PO BOX 161
Mailing Address - Street 2:
Mailing Address - City:DUVALL
Mailing Address - State:WA
Mailing Address - Zip Code:98019-0161
Mailing Address - Country:US
Mailing Address - Phone:425-788-0505
Mailing Address - Fax:
Practice Address - Street 1:15435 MAIN ST. N E
Practice Address - Street 2:SUITE 101
Practice Address - City:DUVALL
Practice Address - State:WA
Practice Address - Zip Code:98019
Practice Address - Country:US
Practice Address - Phone:425-788-0505
Practice Address - Fax:425-788-3340
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00002825225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7090558Medicaid
WA049194OtherL&I PROVIDER NUMBER